[Senate Hearing 108-843]
[From the U.S. Government Publishing Office]
S. Hrg. 108-843
REDUCING CHILDHOOD OBESITY: PUBLIC-PRIVATE PARTNERSHIPS TO IMPROVE
NUTRITION AND INCREASE PHYSICAL ACTIVITY IN CHILDREN
=======================================================================
HEARING
BEFORE THE
COMMITTEE ON HEALTH, EDUCATION,
LABOR, AND PENSIONS
UNITED STATES SENATE
ONE HUNDRED EIGHTH CONGRESS
SECOND SESSION
ON
EXAMINING PUBLIC-PRIVATE PARTNERSHIPS TO IMPROVE NUTRITION AND INCREASE
PHYSICAL ACTIVITY IN CHILDREN
__________
TUESDAY, OCTOBER 5, 2004
__________
Printed for the use of the Committee on Health, Education, Labor, and
Pensions
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COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS
JUDD GREGG, New Hampshire, Chairman
BILL FRIST, Tennessee EDWARD M. KENNEDY, Massachusetts
MICHAEL B. ENZI, Wyoming CHRISTOPHER J. DODD, Connecticut
LAMAR ALEXANDER, Tennessee TOM HARKIN, Iowa
CHRISTOPHER S. BOND, Missouri BARBARA A. MIKULSKI, Maryland
MIKE DeWINE, Ohio JAMES M. JEFFORDS (I), Vermont
PAT ROBERTS, Kansas JEFF BINGAMAN, New Mexico
JEFF SESSIONS, Alabama PATTY MURRAY, Washington
JOHN ENSIGN, Nevada JACK REED, Rhode Island
LINDSEY O. GRAHAM, South Carolina JOHN EDWARDS, North Carolina
JOHN W. WARNER, Virginia HILLARY RODHAM CLINTON, New York
Sharon R. Soderstrom, Staff Director
J. Michael Myers, Minority Staff Director and Chief Counsel
(ii)
C O N T E N T S
__________
STATEMENTS
TUESDAY, OCTOBER 5, 2004
Page
Frist, Hon. Bill, a U.S. Senator from the State of Tennessee,
opening statement.............................................. 1
Wyden, Hon. Ron, a U.S. Senator from the State of Oregon,
statement...................................................... 3
Prepared statement........................................... 5
Dodd, Hon. Cristopher, a U.S. Senator from the State of
Connecticut, opening statement................................. 9
Prepared statement........................................... 11
Harkin, Hon. Tom, a U.S. Senator from the State of Iowa, opening
statement...................................................... 14
Snider, Dixie E., Jr., M.D., Acting Chief of Science, Centers for
Disease Control and Prevention, U.S. Department of Health and
Human Services, Atlanta, GA; and Lynn C. Swann, Sewickley, PA,
Chairman, President's Council on Physical Fitness and Sports,
U.S. Department of Health and Human Services................... 17
Prepared statements of:
Dixie E. Snider, Jr., M.D., MPH.......................... 19
Lynn C. Swann............................................ 24
Potts-Datema, William, Chairman, Action for Healthy Kids,
Director of Partnerships for Children's Health, Harvard School
of Public Health, Boston MA; Ross C. Brownson, Professor of
Epidemiology, Saint Louis University School of Public Health,
St. Louis, MO, Member, Committee on the Prevention of Obesity
in Children and Youth, Institute of Medicine; and Gary M.
Destefano, President, USA Operations, Nike Corporation,
Beaverton, OR.................................................. 39
Prepared statements of:
William Potts-Datema..................................... 41
Ross C. Brownson, Ph.D................................... 45
Gary M. DeStefano........................................ 48
ADDITIONAL MATERIAL
Statements, articles, publications, letters, etc.:
Marshall Manson, Center For Individual Freedom............... 58
(iii)
REDUCING CHILDHOOD OBESITY: PUBLIC-PRIVATE PARTNERSHIPS TO IMPROVE
NUTRITION AND PHYSICAL ACTIVITY IN CHILDREN
----------
TUESDAY, OCTOBER 5, 2004
U.S. Senate,
Committee on Health, Education, Labor, and Pensions,
Washington, DC.
The committee met, pursuant to notice, at 10:22 a.m., in
room SD-430, Dirksen Senate Office Building, Hon. Bill Frist,
presiding.
Present: Senators Frist, Alexander, Dodd, Harkin, and Reed.
Opening Statement of Senator Frist
Senator Frist [presiding]. Good morning.
We are starting a few minutes late, but I do want to
welcome everybody to this hearing on ``Reducing Childhood
Obesity: Public-Private Partnerships to Improve Nutrition and
Physical Activity in Children.'' This is an important hearing.
We are starting a few minutes late because of votes on the
floor of the U.S. Senate. The majority leader just did not know
when to schedule votes. But people will be coming in shortly.
I do want to start by thanking Chairman Judd Gregg for
allowing me to chair today's hearing on a topic that is
critically important to us today, a problem that is worsening
every day. We will respond to our commitment to reversing what
has become a true epidemic in health and in public health in
this country, and to some extent around the world.
Childhood obesity has reached epidemic proportions, and
``epidemic'' is not a word that we should use casually. When we
use the word ``epidemic'' or ``epidemic proportions,'' one
simply need look at the data. The number of obese children
between the ages of 6 and 11 who are in kindergarten to fifth
grade has tripled over the past 3 decades.
Ten percent of American children are clinically obese
today, and more than 30 percent of American children are
overweight. That is, one out of three children in the United
States of America today is overweight.
The numbers are significant because we know that being
overweight, being obese, translates directly into having a
lower quality of life than one's peers, and the translation is
direct. They suffer significantly higher rates of Type 2
diabetes, for example. In my own field of cardiovascular
disease, they clearly suffer from being overweight and obese.
Cardiovascular disease is a term that includes the number one
killers in America today, when you couple stroke, vascular
disease and congestive heart failure, and sudden death.
These young children are more likely to suffer
musculoskeletal problems--problems of muscles and bones and
movement, and that includes degenerative joint disease, disc
disease--and they suffer from a higher number of psychosocial
problems, including depression, and problems of the lung or
pulmonary complications.
After adolescence, children who are overweight have a 70
percent chance of becoming overweight or obese adults.
Individuals who are obese have a 50 to 100 percent increased
risk of premature death. Obesity causes about 400,000 deaths
each year. We will talk a lot about the issues, but poor
nutrition and lack of physical activity is second only to
smoking as the leading cause of death in the United States.
Nonetheless, with a sustained effort and a strong element
of national leadership--and I hope that is reflected by this
hearing today and by my presence at this hearing--we can
improve this situation. It is reversible. It is something that
we can do something about.
That is why we are here today, to focus not on the
problem--because we can define the problem over and over and
over--but on solutions and on innovative solutions and on what
we can do to set policy, working with the private sector to
accomplish that goal of reversing the trends that are so
evident in this epidemic.
Earlier this year, the CDC announced that smoking among
high school students has dropped to its lowest level in more
than a decade. That is good news. Fewer students now say that
they have ever tried cigarettes. The CDC gives part of the
credit to effective anti-smoking media campaigns and anti-
smoking education in the classrooms. That is encouraging news.
It shows that with sustained effort, indeed, progress can be
made in the issues of public health and public health in
children.
It should energize us in the battle against childhood
obesity. The recent CDC report demonstrates that aggressive
education can steer kids away from harmful behaviors through
healthier choices.
This committee has taken a leadership role in developing
legislation to begin to address this growing public health
crisis. Last year, I joined with my colleagues, a bipartisan
group--Senator Chris Dodd, Senator Jeff Bingaman, Senator Jeff
Sessions, Senator Mike DeWine, Senator Lamar Alexander--to
author the ``Improved Nutrition and Physical Activity Act,'' or
IMPACT. That legislation passed the U.S. Senate last December,
and we will build on these bipartisan efforts to continue to
address childhood obesity.
I would like to welcome our first witness, Senator Ron
Wyden of Oregon, who is with us today. Senator Wyden and I
teamed up to sponsor the ``Childhood Obesity Reduction Act.''
We clearly believe, as you will hear shortly, that
intervention, with community and school support, is key to
preventing lifelong obesity and obesity-related illnesses.
We will hear more about the details in that bill, which we
obviously are very, very excited about.
I am very pleased that the Senate has been able to work
across party lines on issues such as this. I am committed
personally as a Member of this Committee, as a physician, as a
United States Senator, and indeed, as majority leader, to
continue to fight against childhood obesity and to use all the
tools within the power of us as Senators to reverse this
growing epidemic. It is serious. It is a significant public
health threat. It is fairly new in terms of history--we are
talking about the last 30 or 40 years--and in many ways, that
gives me hope, because it shows something that for years and
years and years was not a problem and then has become an acute
problem over several decades, and now we are at a critical
point in history where we can reverse it--not just we, but we
working hand-in-hand through innovative and creative
partnerships.
I do want to welcome all of our witnesses today, and I look
forward to hearing your testimony.
We have three panels today, and I know there are certain
time constraints, so we will move through the panels fairly
expeditiously.
What I would like to do--and I will turn to my colleagues
to see if it would be okay--is to allow Senator Wyden to go
ahead and begin the first panel, and after that, allow them to
make statements at that juncture.
Senator Wyden?
STATEMENT OF HON. RON WYDEN, A U.S. SENATOR FROM THE STATE OF
OREGON
Senator Wyden. Thank you, Mr. Chairman.
Mr. Chairman, let me tell you how much I appreciate being
here and being with you especially. I think it is pretty
obvious that the Senate Majority Leader in the last week--or
what we hope will be the last week--of the session has one or
two things on the plate. And the fact that you are here and
that you are leading this hearing is, I think, further evidence
of how serious you think the problem is. I appreciate that
leadership and particularly the chance to team up with you.
I think it is also fair to say that Senator Harkin has been
prosecuting this cause for a long, long time--he has his own
bill and a lot of very good initiatives in it--Senator Kennedy
as well, and Senator Reed, who has long been an advocate for
kids. This has the makings of a good bipartisan partnership.
Mr. Chairman, with your leave, if I could just put my full
statement in the record and just highlight a few of my concerns
this morning.
Senator Frist. Without objection.
Senator Wyden. First, I think that from a statistical
standpoint, you have laid it out. You cannot overstate the
enormity of this problem.
Across the country, as our kids slouch in front of TVs and
video game consoles, they are being stalked by this silent
killer known as obesity. I think this committee understands
what we are up against. Members introduced their own
legislation. And our bipartisan bill, the bill that you and I
have introduced, is based on the proposition that kids are not
going to be able to escape this killer all by themselves. Far
too few grownups have been working to assist them, and part of
the problem is that a lot of those adults are facing the same
killer as well.
What I hope we can do with our legislation is jump-start a
nationwide, community-based mobilization against this killer--
and it is fair to say if you are going to ask the country to
mobilize, the Congress has got to lead the way. Kids are not
going to change their eating and exercise habits by osmosis, so
adults, and particularly the Congress, are in a position to
speak out and to lead.
From the standpoint of my own State, the Centers for
Disease Control has said that at least 31 percent of the low-
income kids between the ages of 2 and 5 in Oregon are
overweight or at risk of becoming overweight. My sense is that
the country has a choice. We can either step in now and act
with the kind of legislation that we have introduced and other
members of this committee have introduced, or we can
essentially commit ourselves to playing catch-up ball for years
and years to come. We will be playing catch-up ball in terms of
health care.
Certainly, if you look at the diabetes statistics, just as
an indication of that, diabetes is killing three times as many
people in Oregon today as it did 15 years ago. And certainly,
from the standpoint of being overweight and obese, you are
increasing the risk of youngsters for diabetes, and this will
lead to that spiral of more chronic illnesses.
So the choice, as I say, is that we can either act
aggressively today, or we can play catch-up ball for years and
years from the standpoint of health and finances. And
certainly, if you look at the toll that diabetes takes, we are
now at the point in terms of annual U.S. medical expenditures
where we are spending $75 billion in 2003 dollars, and half of
those expenditures, Mr. Chairman and colleagues, are now
financed by Medicare and Medicaid.
So I will close by way of saying that there are really two
steps that we are trying to take in our bill, the Frist-Wyden
legislation, the ``Childhood Obesity Reduction Act.'' The first
is based on the idea that it would be useful to have a one-stop
shop to fight obesity. We do that by creating a congressional
council so that through a website, you can get state-of-the-art
information out across the country to those who are looking in
schools and public-private programs for programs that work.
So, for example, in the first part of our legislation, the
education part, if a teacher sees a study, for example, like
the one that was recently released showing that 30 minutes of
activity can help combat childhood obesity, but the school does
not have the resources, or has had their physical education
program cut, through the website, that teacher will be able to
find out about schools and programs in a similar situation and
know where to turn. For example, say they were a school
strapped for resources or had had their P.E. program cut. They
would be able to find out that Nike, which is fortunately
located in my home State, a Fortune 500 program, is willing to
step up to the plate and help them establish a program along
those lines in a school that is strapped for resources.
The second part of our legislation, Mr. Chairman and
colleagues, assumes that we are not just going to get this done
by having a congressional committee act once and pass one piece
of legislation, but we are going to need to have an ongoing
basis for not only getting the information out but for making
resources available. So our legislation establishes a
congressional council as well to run a foundation that would
assist both in terms of education and resources.
So let us say, for example, that you have an urban school
that is trying to get youngsters to eat a few more vegetables
and a few less french fries--certainly a problem that we are
seeing on a widespread basis. Not only can we through the
foundation get information out to those schools, but the
foundation would have the resources, for example, to provide
that low-income urban school some seed money so that that urban
school could set up a garden that would produce fresh produce
and help to change the way that youngsters look at food.
The last point that I would make, Mr. Chairman, is I think
we ought to learn from some of the lessons that this committee
and colleagues have tackled aggressively. If you look, for
example, to parallels with respect to tobacco, my sense is that
some of the lessons that we have learned in terms of fighting
youth smoking can also be applied as we tackle this question of
childhood obesity.
So I think all of us here have the same goal, and that is
to get America's kids healthy. The challenge is going to be
tough, because there is a lot of food out there that tastes
pretty good but is not particularly nutritious, and there are
video games that do not burn any calories but sure are an
entertaining way to spend an afternoon.
So I think with these kinds of efforts and the good work
that this committee has done, we can mobilize the country and
have the Congress take the lead and beat this, as you correctly
characterize it, epidemic of obesity among kids.
Senator Frist. Thank you very much, and I personally
appreciate your strong advocacy, passionate advocacy, for
reducing childhood obesity. It has been a real pleasure working
with you on this huge challenge for the American people.
[The prepared statement of Senator Wyden follows:]
Prepared Statement of Senator Wyden
Across this country, on couches in front of televisions and
video game consoles, a silent killer called obesity is stalking
America's youngsters--in epidemic numbers.
This committee has a sense of the implications of this
obesity epidemic, because several of you have had a long
interest in solving this issue. In particular, I want to
commend Senators Harkin, Kennedy and Gregg.
Senator Frist and I have introduced a bipartisan bill based
on the proposition that children can't escape this killer on
their own. And far too few grownups are working to save them--
one reason being that the grownups are fighting the same
killer, too. What Majority Leader Frist and I hope to do with
our legislation is to jump-start a nationwide, community-based
campaign against this menace. There must be a national
mobilization to help our kids grow up healthy. And when I say
the country must mobilize, I am calling on this committee and
this Congress to lead the way. Just as children won't change
their own eating and exercise habits by osmosis, so the adults
of this country will not take up the fight against obesity
without leadership and help.
Let me share with you just one devastating example of the
problem: In my home State of Oregon, obesity may well become
the number-two killer of our citizens--after tobacco, the
number-one killer nationally.
According to the Oregon Department of Human Services, fully
22 percent of the adults in Oregon are obese and 60 percent are
overweight. The Centers for Disease Control found the obesity
rate among Oregon adults increased by 86 percent from 1990 to
2002. Even more tragic, and why we are here today, is that CDC
says at least 31 percent of low-income children between 2 and 5
years of age in Oregon are overweight or at risk of becoming
overweight. A lot of those overweight kids are going to become
overweight and obese adults if we just sit on our hands today.
We're going to end up playing medical catch-up ball, and
financial catch-up ball, for the rest of their lives.
Here's an example for you: Diabetes kills three times as
many people in Oregon today as it did 15 years ago. The truth
behind that figure is, that being overweight or obese
dramatically increases a child's risk for diabetes--and that
can lead to more chronic illnesses. Diabetes is the leading
cause of kidney disease, heart disease, amputation and
blindness. The Centers for Disease Control and Prevention
estimates that due to this epidemic of obesity, one in three
Americans born in the year 2000 will develop diabetes in their
lifetime and for minorities that number jumps to nearly half.
Think about that. A lot of folks in this room have children
and grandchildren who are young right now, or still on the way.
And the numbers don't look good for the kids that we love. And
those numbers don't measure the emotional toll that illness
takes on a child, their families and others who love them.
The financial costs are staggering as well. In January,
research was released showing the cost of obesity to our health
care systems. The research looked at adult obesity health care
costs and concluded: annual U.S. medical expenditures because
of obesity are estimated at $75 billion in 2003 dollars, and
approximately one-half of these expenditures are financed by
Medicare and Medicaid.
And if we do nothing to help our children get fit and stay
fit, those figures will only grow as more overweight kids
become overweight adults. Obesity among children is up. But the
dollars being spent now, on their obesity-related diseases in
childhood, are just a drop in the bucket compared to what we're
going to have to spend. Many obesity-related diseases are
chronic and lifelong. Again, it's a prescription for catch-up
ball.
Here's how the Frist-Wyden bill, the Childhood Obesity
Reduction Act, will work to turn the tide against childhood
obesity. There are TWO ways this will happen.
First, it will give teachers, parents and other community
leaders a one-stop shop to fight obesity. The Congressional
council created by this bill will launch a comprehensive
website to help everyone from PE teachers to scout leaders
learn what's working in schools and public-private programs.
But it doesn't stop there--it will also offer advice on
connecting with those successful programs and adapting them in
their own schools.
Let me give you a real-world example of how this component
will work: When a teacher sees a study like one that was
released recently showing that 30 minutes of activity can help
combat childhood obesity, but the school doesn't have the
resources or has had to cut their physical education program,
that teacher could go to the website and see what others in a
similar situation have done to remedy that problem. They would
be able to see there are partners like Nike who are willing to
step up to the plate and help with programs. But that teacher
might also see that physical activity is only one part of the
solution and they might find ways to bring in the nutritional
aspect as well through other programs that have already proven
successful.
The website will also offer help in establishing goals for
cutting childhood obesity at that school or in that community--
and all these plans will have been evaluated by outside experts
for their effectiveness.
That's the first component of our bill. Here's the second.
Secondly, once the one-stop shop is established, it will be
time to move to the next level. We're not setting up a
permanent congressional committee where politicians can take
root and it all gets run from the government.
After 2 years, the Congressional council turns the work
over to a brand-new foundation. The foundation will keep the
one-stop website up and running. But at the same time, they'll
be able to raise money, and use it to reward programs that work
and fund programs that are sorely needed where childhood
obesity threatens most.
Here's an example of how the second component of our bill
would work: say an urban school wants to work on getting kids
to choose vegetables instead of French fries--which would be a
huge step in the battle against childhood obesity. When they
visit the website, they may find a successful program about
actually growing fresh vegetables--so they don't think
vegetables just come from a freezer or a can. The Foundation
will have the wherewithal to do more than just share that
information--they may be able to provide the seed money,
literally, for a school garden that will grow fresh produce,
and change the way those children look at food.
It is not realistic to think that children won't be in a
situation where unhealthy choices for foods and snacks are
available. The goal ought to be help them know what the healthy
choices are, how to balance what they eat and drink so they
make better choices and to know that they need exercise--
particularly if they want to have that not so nutritionally
perfect snack. And the foundation can keep pursuing those goals
for the long term.
As I close, let me share with you another startling fact
about obesity: spending on obesity-related medical care is
starting to rival the spending related to smoking. We know the
toll tobacco-related diseases have taken on our citizens and on
health care costs. When you consider that obesity-related
illnesses are following that terrible track, how can we refuse
to act to help our children avoid a future of disease and
illness?
I've spent a good part of my public service fighting Big
Tobacco and working to make sure kids can grow up without
having cigarettes thrown at them and ads enticing them. And
over time, the many actions of individuals, organizations and
government have had success in slowing the number of kids
addicted to nicotine. We can't let up on that effort, and now
we must also act to help our kids become fit and stay fit.
It doesn't take a rocket scientist to figure out that these
two killers--tobacco and obesity--have a lot in common. Big
tobacco targets younger Americans and children around the world
because those who begin smoking earlier in life tend to stay
hooked longer. Children who don't learn good eating and
exercise habits tend to carry that weight on into adulthood. I
believe the lessons of the successful effort that has been
waged against childhood smoking can and should be applied in
the campaign against childhood obesity. That means taking
action now.
I know that members of this committee feel as passionately
about this issue as I do. What our legislation has in common is
an emphasis on addressing both sides of the equation--nutrition
and physical activity. One without the other will not make our
children healthy. But I do believe that the Wyden-Frist bill is
significant because it will create an immediate, one-stop
resource, in the form of a website, about what we know is
working now so that individuals can begin to mobilize their
communities and help their children. Senator Harkin's proposal
for example, also has an emphasis on research and preventive
services; I think those are also important steps in assisting
our children become healthy adults.
All of us have the same, simple goal here: getting
America's children healthy. There are a lot of folks competing
for our kids' attention in this arena. A lot of the competition
is pretty attractive: food that's not so nutritious but sure
tastes good, and video games that don't burn any calories but
can occupy you for an entire afternoon. It's tough for kids to
make good choices on their own. That's why it's time to
mobilize this Nation--and particularly this Congress, by way of
legislation--to beat the epidemic of obesity plaguing our
children.
Senator Frist. I have, in order of arrival this morning,
Senators Harkin, Reed, and Dodd. Tom, would you like to proceed
now with an opening statement or questions. We can go ahead and
do opening statements here, if you like, or questions for Ron.
Senator Harkin. Thank you, Mr. Chairman.
I would like to make an opening statement, but I don't want
to keep Senator Wyden here. I know we are all busy at this time
of the year. I just wanted to thank Senator Wyden and you, Mr.
Chairman, at the outset for your interest, your leadership in
this area. We can all learn from one another. I think we are
all basically pulling in the same direction, and if we just get
all our harnesses together, we can make some great headway, if
not this year--I know we are coming to a close in the
Congress--but with your leadership in the Senate and your
leadership on this committee and your stature as a physician
and your own healthy lifestyle, I think we can really make some
moves here and get ahead of this ball game.
I will have more to say in my opening statement, but I
particularly wanted to thank Senator Wyden and you, Mr.
Chairman, for your leadership in this area, and I would like to
reserve my time just to make an opening statement.
Senator Wyden. And without turning this into a bouquet-
tossing contest, let me be clear--I am very much aware that
Senator Harkin has been prosecuting this cause for a long time,
and you have a good bill, and we are anxious to all work
together.
Senator Frist. And one of the exciting things over the
course of the morning will be the great individual efforts, and
now is the time to really pull a lot of that together over the
coming days, weeks, and months. That is going to be the
message, I think, coming out of this hearing today.
We will come back for opening statements.
Let me turn to Senator Reed for questions for Senator
Wyden, and then Senator Dodd, and then what we will do is come
back and allow Senator Wyden to depart if he needs to, or he is
welcome to come to the dias and observe from the dias as well.
Senator Reed?
Senator Reed. Mr. Chairman, I simply want to thank you for
arranging the hearing and thank Senator Wyden not only for his
testimony today but for his efforts in many respects, but
particularly with regard to children.
Thank you.
Senator Frist. Thank you.
Senator Dodd?
Opening Statement of Senator Dodd
Senator Dodd. Thank you, Mr. Chairman, and I thank you as
well, Ron, for your work in this regard.
This is a critical issue, and I think your passion and your
interest in it are well-placed.
I can recall a while back when Senator Bingaman and the
majority leader and I introduced the IMPACT bill, which is a
very modest bill, really, to put some resources into this.
There were actually editorial comments around the country that
sort of ridiculed the effort somehow, that now the government
was going to tell you what to eat and what not to eat, and the
notion that somehow we were overstepping our bounds by even
engaging or discussing the issue.
Senator Harkin. ``Nanny government.''
Senator Dodd. They called us ``nanny government'' by
talking about it, and what a foolish notion--yet that idea
permeated a lot of the journalistic comment on the subject
matter.
And of course, the statistics scream out to the contrary--I
know you have cited some of them already, Ron, but they are
worth repeating--from the Institute of Medicine on this
epidemic--and it is an epidemic--that is occurring in the area
of obesity, particularly with kids.
The prevalence among children ages 2 to 5 and 12 to 19
years of age has doubled since the 1970's. Even more troubling,
we now know that the rate of obesity has tripled over the same
period of time for children between the ages of 6 and 11.
This alarming report tells us that there are currently more
than 9 million obese children over the age of 6.
Of additional concern, of course, is the cost. We have
talked about it again here, but it deserves repeating. We have
often talked about children's obesity and the growing
relationship to Type 2 diabetes. This is truly alarming. As the
chairman knows all too well, the deadly disease was once
commonly referred to as ``adult-onset diabetes.'' Sadly, this
term can no longer be used to refer to a disease that 30
percent of boys and 40 percent of girls are at risk of
developing due to the growing problem of childhood obesity.
Just as troubling as the physical dangers associated with
child obesity are the related emotional and psychological
problems that many overweight and obese children face as a
result of significant stigma surrounding obesity. Sadly, the
growing prevalence of childhood obesity has not lessened its
negative image. Overweight and obese children often face
ridicule and scorn by their peers. Such treatment can lead to
long-term and debilitating psychological burdens as well.
We as a society cannot ignore the great financial cost the
IOM report attributes to the tripling of obesity related to
hospital costs for children and youth to $127 million for the
years 1997 and 1999.
There are two factors, obviously. The eating problem is
obviously there, and physical inactivity, and we have talked
about these.
One of the concerns that I have raised in the past, and I
know Senator Harkin has and Senator Reed has, is that if we
look at poor school districts, they too often end up signing
contracts with food providers that insist that their products
be sold exclusively during school hours. And they need the
money because they are broke, and they are relying on a
desperately poor constituency to supply the necessary property
taxes to support their school effort.
It is one of the great tragedies, in my view, that we allow
this to continue, where these kids have no other choices during
the school year but to eat some of the products that are being
sold through the vending machines and the like.
Forty percent of our children watch more than 2 hours of
television a day, under-age kids, just sitting there day after
day. It has become the child care situation of choice for
people who cannot afford the $6,000 to $10,000 a year per child
that is the average cost of a private child care setting. If
you have two or three children, and you are making $35,000 a
year, the math is not complicated--TV becomes the choice
babysitter, child care provider.
So, Mr. Chairman, I will ask unanimous consent that the
remainder of these opening comments be included in the record.
Senator Frist. Without objection.
Senator Dodd. I would hope that in the waning days, the
Senate would unanimously pass the bill that Senator Frist and
Senator Bingaman and I introduced a couple of years ago, on
which the House has yet to take up action. It would not take
much to put that on the consent calendar in the next 72 hours
before they adjourn and send it down to the President for his
signature. It would put some money in flow to the States for
grant applications to begin to deal with the issue.
As I said, it is a rather minor bill--I am not suggesting
that this is in any way going to solve the problem--but it is
sitting out there in the House of Representatives--passing
unanimously here. There are not many bills that go through here
unanimously, but I think it is an indication of the common
concern that we all share about this growing problem.
So, thanks, Mr. Chairman, for doing the hearing today.
I know you are busy as majority leader, so to take time--
the majority leader taking the time to conduct a hearing in the
waning days of the session, I think speaks volumes, one about
this Member, but also about the seriousness of this issue.
And I thank Ron, of course, for his continuing leadership
on these issues, and I am not surprised that Tom Harkin and
Jack Reed would be here caring about it as well given their
long history and involvement with these issues.
Thank you, Mr. Chairman.
Senator Frist. Thank you.
[The prepared statement of Senator Dodd follows:]
Prepared Statement of Senator Dodd
Good morning, Mr. Chairman, and thank you for convening
today's important hearing on the issue of promising initiatives
to address the growing problem of childhood overweight and
obesity.
As you know, Mr. Chairman, the costs of overweight and
obesity are simply staggering. Both the United State Surgeon
General's Call To Action To Prevent and Decrease Overweight and
Obesity and the just-released Institute of Medicine (IOM)
report, Preventing Childhood Obesity: Health in the Balance,
estimate that each year we lose close to 400,000 Americans--
more than 1,000 lives each and every day--as a direct result of
obesity. The financial costs of obesity and overweight also
cannot be ignored, Mr. Chairman. The same reports estimate that
the economic cost of obesity in the United States was more than
$117 billion in 2000 alone. And tragically, we learned earlier
this year that obesity will soon overtake smoking as the number
one cause of preventable death in our Nation.
For our Nation's children, Mr. Chairman, the toll that
obesity and overweight extracts is even more severe. With the
release just last week of the report by the IOM, we know that
we literally face an epidemic of childhood obesity. We know
that the prevalence of obesity among children aged 2-5 and 12-
19 years has doubled since the 1970s. Even more troubling, we
know that the rate of obesity has tripled over the same time
period for children between the ages of 6 and 11. This alarming
report tells us that there are currently more than 9 million
obese children over 6 years of age.
Of additional concern, Mr. Chairman, are the costs
associated with childhood obesity, be they physical, emotional,
or financial. Childhood obesity's growing relation to type 2
diabetes is truly alarming. As the Chairman knows all too well,
this deadly disease was once commonly referred to as ``Adult
Onset Diabetes.'' Sadly, this term can no longer be used to
refer to a disease that 30 percent of boys and 40 percent of
girls are at risk of developing due to the growing problem of
childhood obesity.
Just as troubling as the physical dangers associated with
childhood obesity are the related emotional and psychological
problems many overweight and obese children face as a result of
the significant stigma still surrounding obesity. Sadly, the
growing prevalence of childhood obesity has not lessened its
negative image. Overweight and obese children too often face
ridicule and scorn from their peers. Such treatment can lead to
long term and debilitating psychological burdens.
Additionally, we as a society cannot ignore the great
financial costs associated with the childhood obesity epidemic.
The IOM report points to the tripling of obesity-related
hospital costs for children and youth to $127 million for the
years of 1997-99.
We know, Mr. Chairman, that overweight and obesity are as
result of two factors--unhealthy eating choices and physical
inactivity. And while we all enjoy foods that may not be in our
best interest at certain times, when we combine unhealthy
eating habits with a lack of physical activity we are literally
courting serious health risks. The lack of physical activity in
the United States is truly alarming, with less than one-third
of adults engaging in the recommended amounts of physical
activity. Add to this the fact that more than 40 percent of our
children watch more than 2 hours of television each day, and it
becomes apparent why we are growing heavier as a society.
The situation for children is even more dire when you
consider the predicament facing many of America's schools and
their ability to provide meaningful physical education. Right
now, only 8 percent of elementary schools provide daily
physical education. With funding tight, and with the new
requirements of No Child Left Behind, many schools are being
forced to make difficult budgetary decisions. Understandably,
they're doing everything they can to keep class sizes small and
to avoid laying off teachers in courses like English, math, and
science. Unfortunately, the result is that physical education
is often first on the chopping block.
As the Ranking Member of the Subcommittee on Children and
Families, I am particularly concerned that many of our children
face unhealthy food choices at the one place where they spend
most of their time--their schools. And while I realize that
some schools enter into contractual obligations with food
providers so that they can earn needed dollars that in turn
fund valuable school services such as music, art, and athletic
programs, I am concerned that funding shortages should not pit
needed services against the best interest of our children's
health.
Despite all of this very disturbing information, our Nation
is just now beginning to realize the gravity and scope of the
obesity epidemic. Sadly, many would have us believe that there
are quick-fix solutions to the problem of obesity. While it's
true that in the past we've successfully eradicated public
health threats like smallpox and polio, obesity is a different
kind of disorder. As best we can tell, there is no miracle cure
for obesity that comes in the form of a pill or a shot. What is
needed to address obesity today is an aggressive, multifaceted
strategy. It needs to incorporate both the public and the
private sectors. And it needs to be implemented at every
level--from the Federal Government all the way down to
individual families. We need to recognize that everyone bears a
share of the responsibility for this problem, and that everyone
should be part of the solution.
Based on these ideas, Senators Frist, Bingaman, and I have
introduced the Improved Nutrition and Physical Activity Act, or
IMPACT. I'm happy to say that this legislation, in modified
form, passed the Senate unanimously late last year. I'm hopeful
that before this year is out, the House of Representatives will
pass it as well so it can become law. Admittedly, IMPACT is a
first step--not a complete solution. Certainly, none of us
believe that this bill, should it be signed into law, will by
itself solve the problem of obesity.
The actual provisions in the legislation are fairly modest
ones. IMPACT takes three basic steps. First, it expands
existing Federal grant programs so they can be used to help
fund obesity treatment, education, and prevention. Second, it
authorizes a number of new studies that will help us learn more
about the scope and nature of obesity. Finally, IMPACT
establishes a number of demonstration projects for new
initiatives aimed at reducing obesity so we can learn which
approaches work, and which ones do not.
All in all, as I said, these measures are modest. But they
are a good start. And IMPACT serves an important purpose aside
from its specific provisions--by outlining a basic strategy for
addressing this obesity epidemic in the United States.
Mr. Chairman, most kids in America are familiar with the
saying, ``you are what you eat.'' But few of them know what
that really means. It's time that they learn the difference
between a calorie and a carbohydrate. It's time that all
Americans--adults as well as children--learn basic facts about
sugars, fats, and all the other figures that you can find on
the package of virtually every item of food you can buy in
America today. I've always believed very deeply that a good
education can open the door to a lifetime of opportunity. By
the same token, a good education about proper nutrition can
open the door to a longer, fuller, and healthier life.
Education about nutrition, though, will matter little
unless Americans have the opportunity to choose to eat healthy
foods. For many American children, their choice of lunch each
day is determined by what's on the menu in the school
cafeteria, or what's available in a vending machine. However,
low-income Americans have their choices restricted for a very
different reason: they can only eat what they can afford to
buy. For these Americans, it's not just enough to make healthy
foods available. We need to make them affordable as well. Drive
through a low income neighborhood in America today, and you can
find a fast-food restaurant on virtually every block. But how
many of these neighborhoods have stores that carry fresh,
quality produce and other nutritious foods at affordable
prices?
It won't be easy to turn the tide on obesity, and childhood
obesity in particular. It will require a long-term, sustained,
comprehensive, national effort that changes hearts, minds, and
lifestyles. But at the same time, obesity is, above all, a
disorder that we ourselves have the power to prevent. I have
every confidence that if we make the necessary commitments, we
can find a solution to this very serious national problem, just
as we have solved so many crises that have confronted our
Nation in the past.
Lastly, Mr. Chairman, let me thank you for your leadership
on this issue. The toll of overweight and obesity on our
Nation's health clearly cannot be dismissed. I look forward to
continuing working with you, as well as other committee members
and our witnesses today, to advance meaningful Federal
initiatives to combat childhood obesity.
Senator Frist. Senator Wyden, thank you for being with us,
and again, you are welcome to join us to observe from the dias.
Senator Wyden. Thank you, Mr. Chairman.
Senator Frist. What I would like to do is introduce the
second panel, and then I would be happy to turn to Senator
Harkin for his opening statement.
If I could ask the second panel to come forward as I
introduce them.
Dr. Dixie Snyder is chief science officer for the Centers
for Disease Control and Prevention. He provides guidance on the
scientific integrity and quality of agency programs and
assistance in resolving controversial scientific issues and
holds the rank of Assistant Surgeon General Rear Admiral.
Lynn Swann does not need an introduction. He is a member of
the NFL Hall of Fame, as we all know, for his outstanding
career as a receiver in the NFL, winning four Sugar Bowls with
the Pittsburgh Steelers.
Senator Dodd. Super Bowl.
Senator Frist. Super Bowl. What did I say?
Senator Harkin. Sugar Bowl.
Senator Frist. You may as well; you need them all.
[Laughter.]
They were sweet. Lynn Swann is here with us today as chair
of the President's Council on Physical Fitness and Sports. I
have had the opportunity to know Mr. Swann and his deep-felt
commitment for improving the health of others, for a healthier
lifestyle but also for a healthier America. So I appreciate
both of you being with us today.
Let me turn to Senator Harkin again. He deferred his
opening statement, and I would like for him to make that now.
Again, it is a real pleasure to turn to him because on so many
of the issues that I am committed to, he has led the way for
years and years and years, and it gives me a great deal of
pleasure to join him and, really, all of my colleagues here
today in addressing these major public health crises that
sometimes get pushed to the background, yet we see that they
are emerging in ways that are destructive to society.
Senator Harkin?
Opening Statement of Senator Harkin
Senator Harkin. Mr. Leader, you are overly generous and
overly kind. Again, I just respect you so much in your efforts
in this regard, both professionally as our leader but also in
your own personal example of your healthy lifestyle and the
example you set for others. That is very, very important, and I
just want to thank you for having this hearing.
I was delighted to join with you and, actually, with
Senator Dodd and Senator Bingaman. We sent a letter in May to
have a hearing on obesity. I know we are all busy, but I think
the fact that we are now having this hearing under your
leadership is very, very important. You are the leader of the
Senate, and as I said earlier, because of your status as a
physician, I think that puts a heavy stamp on what we are doing
here. I know you are very busy this week, and this says
something, the fact that you would be here today to do this.
So again, I really look forward to working with you and so
many others on this critical issue. You did say that. You said
it was a critical point, that we have reached a critical point.
And a number of leading health experts are now predicting that
this generation of kids growing up today could be the first to
live a shorter lifespan than their parents. That is amazing. A
significant reason for this is the obesity epidemic, which is
about to overtake tobacco as the number one killer in our
society.
By now, the devastating effects of obesity on child health
are quite well-known. I do not need to go through that. But I
did want to hold up here and note the Institute of Medicine's
report that just came out on ``Preventing Childhood Obesity.''
It has it all right in there.
I think what the Institute of Medicine has shown, Mr.
Chairman, is that half measures will not work. You cannot just
focus on one thing and think it is going to solve it. It has to
be a very comprehensive national response. It is a clarion call
to us as individuals, families, as well as schools, employers,
communities, and the food industry. But most of all, it is a
clarion call to Congress for us to act boldly.
The blueprint for action set forth in this report, I am
pleased to say, tracks very closely a bill that I have
introduced, S. 2558, the ``Healthy Lifestyles and Prevention
Act.'' Again, it is comprehensive. As Senator Wyden said, I
have been involved in this for some time. I remember in 1996 on
the farm bill, I introduced an amendment to take vending
machines out of schools. As you can see, I was spectacularly
unsuccessful with that amendment. We could just never do
anything.
Go back to 1978, when the FTC promulgated some proposed
regulations on advertising to kids, and the hue and cry that
went up at that time; and in 1980--Senator Dodd was on his way
over here, but I was still in the House--we passed legislation
that took away the authority of the FTC to regulate advertising
to kids.
Mr. Leader, I bet very few people know that today as we sit
here, the FTC has more authority to regulate advertising to you
and me and Senator Dodd and all the adults here than it does to
our kids or grandkids. That is a fact.
So something has got to be done about this. It is just like
other things. We have a highway bill. You ask what does a
highway bill have to do with obesity. In Europe today, you
cannot build a bridge unless you have a walking path or a bike
path attached to it. Look at what we do here in America. My two
kids went to a public high school not too far from here in
Virginia. It is a mile from our house. I wanted them to walk.
It is a good deal--walk to high school and back--one mile, that
is no big deal--except there are no sidewalks, and we are on a
busy street. I would not let them ride a bike down that street
because it is a busy thoroughfare. So, no sidewalks even to get
to school.
We are building subdivisions in America today without
sidewalks. How can kids walk to school if there are no
sidewalks, or if they cannot get across a bridge because there
are no pathways?
So I am just saying that it has got to be comprehensive.
``No Child Left Behind,'' for example--we are all for making
sure kids test out and that we do not leave any child behind,
but Mr. Leader, there is no test for kids on their physical
fitness--none. We want kids to be smart, yes, but part of life
is also being physically fit, too. There is nothing in there on
that.
We have elementary schools today being built without
playgrounds. That ought to be unconscionable--elementary
schools built without playgrounds. The average elementary
school kid in America today gets less than 1 hour a week of
P.E.--less than 1 hour. That is average. That is just
unconscionable that we would go down that path.
And then, the marketing of food to our kids--as I said,
since 1973, the industry has had a self-appointed regulatory
body, but look how effective it has been. Right now, the
industry is spending about $12 billion a year bombarding kids
with junk food ads. Just watch your Saturday morning TV shows
and see that. That is all it is.
We go to high schools, and we see all these vending
machines that Senator Dodd talked about. In every vending
machine now, you get a 20-ounce Coke--I do not mean to pick on
Coke--Pepsi, RC Cola, the whole thing.
It was Dr. Kelly Brown who pointed out to me once, and I
found it startling, that one 20-ounce cola has 15 teaspoons of
sugar. How many parents would send their kids to school in the
morning and measure out 15 teaspoons of sugar and say, ``Here,
you can have that''? Well, make it double; we will double that.
Yet they will think nothing of them going and getting a 20-
ounce soda out of the vending machine--15 teaspoons of sugar.
So when it comes to that kind of thing, we have got to
think about foods in schools, physical activity. And the
workplace--of course, that has nothing to do with children and
childhood--but that has to be part of it, too.
But in fact, as you said, Mr. Chairman, Mr. Leader--and you
are right--you have got to get at the kids. It is how we start
our lifestyles, what we do at an early age.
One last thing I would just mention--not that I am trying
to pat myself on the back or anything--but in the last farm
bill, we put in a pilot program in four States, one Indian
reservation, giving free fresh fruits and vegetables to kids--
free--not during the lunch hour, not in the lunch room, but
during the day, any time they wanted them. From the time they
walked in the door to the time they left, they could get fresh
apples, pears, kiwi fruit, grapes, oranges, bananas, all that
kind of stuff--free--no questions asked.
We did that in four States. It has only been 2 years now,
but you should look at the success of this. The teachers love
it; the principals love it; the kids love it. And guess what?
We have had testimony in our Appropriations Committee of
schools that have actually taken vending machines out because
they are not being used anymore, because the kids are eating
the fresh fruits and vegetables. That is only 100 schools in
America. This needs to be expanded out so that these kids can
get the free fresh fruits and vegetables that they need.
So there are all kinds of things that we need to do, and we
need to do it in a collaborative effort. I believe that all
aspects need to be addressed, and that is where the private
sector can come in and help greatly. I thank Nike. I have read
their testimony and what they are doing. I do not mean to
single them out, but they should be; they are doing good stuff.
That is the private sector. We can do it here in Congress.
We need to work with school boards and school districts. And we
also do need some regulatory authority. Maybe people do not
like that. They talk about ``nanny government.'' I am sorry.
When the FTC has more authority to regulate advertising to you
than it does to my grandkids or kids, there is something wrong.
We need to have that kind of regulation as a part--it is not
one thing--but as part of the overall picture of addressing
childhood obesity.
Mr. Leader, you have been very kind to give me this time,
and I thank you very much. I share with you this passion that
we have got to get to these kids early on in life, and it has
got to be a comprehensive type of approach.
Thank you.
Senator Frist. Thank you, Senator Harkin.
I could not help but think as you talked about the four
States and the 100 schools--Senator Wyden and I in our bill,
the ``Childhood Obesity Reduction Act,'' want to take and set
up a mechanism to take that sort of success and publicize it,
celebrate it, because when you hear about it, it makes sense,
especially if the results are very positive, to spread that
around the country. But it is one of the issues that, when
people look at our bill, they will see that we have the vehicle
to accomplish just that.
Let us turn to our panelists. I have introduced you, Dr.
Snider, so let us start with you, followed by Mr. Swann, and
then we will come back and ask questions, and we will start the
questioning with Senator Reed when he comes back.
STATEMENTS OF DIXIE E. SNIDER, JR., M.D., ACTING CHIEF OF
SCIENCE, CENTERS FOR DISEASE CONTROL AND PREVENTION, U.S.
DEPARTMENT OF HEALTH AND HUMAN SERVICES, ATLANTA, GA; AND LYNN
C. SWANN, SEWICKLEY, PA, CHAIRMAN, PRESIDENT'S COUNCIL ON
PHYSICAL FITNESS AND SPORTS, U.S. DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Dr. Snider. Thank you, Mr. Chairman.
As a former house officer at Vanderbilt, I appreciate the
opportunity to participate in today's hearing.
Members of the Committee and Mr. Chairman, we really
appreciate the support that you have given to us for all of our
chronic disease efforts, particularly in this area.
Today I will present a brief overview of our overweight
epidemic in our Nation's children and identify some of the
Department of Health and Human Services' initiatives and
programs designed to combat the combined epidemics, as you
indicated, of poor nutrition, physical inactivity and obesity.
I will submit my written comments to the record.
Since 1980, as has been mentioned, the prevalence of
overweight has more than doubled among children and tripled
among adolescents. The latest data available from CDC from the
NHANES, the National Health and Nutrition Examination Surveys,
show that between 1999 and 2002, 16 percent of children and
adolescents were overweight, and another 15 percent were at
risk for overweight. The increases in overweight among children
and adolescents cut across all regions of the country, all
ages, all racial and ethnic groups. However, we do know that
African American, particularly females, and Mexican American
youth, particularly males, are more overweight compared to
white youth.
As we know, the primary concern of overweight and obesity
is one of health, but as has been mentioned, there are issues
of appearance and the impact on the child.
Most of the disease associated with overweight and obesity,
of course, occurs later on in adults, but children who are
overweight often develop risk factors for diseases such as Type
2 diabetes, high blood pressure, and elevated cholesterol
levels. Sixty percent of overweight children have at least one
additional risk factor for cardiovascular disease, and 25
percent have two or more.
As has already been mentioned, Type 2 diabetes, which we
used to see only in adults, is strongly associated with
obesity, and it was virtually unknown in children and
adolescents 10 years ago. We saw Type 1 diabetes, juvenile
diabetes; we did not see Type 2. But today it accounts in some
communities for more than 50 percent of the diabetes we see.
Childhood overweight is also associated with
discrimination, poor self-esteem, and depression.
Overweight adolescents have a 70 percent chance of becoming
overweight or obese adults--and that is very disturbing.
Childhood overweight that persists into adulthood is typically
more severe than overweight or obesity that develops during
adulthood. For example, in the Bogalusa Heart Study, 50 percent
of those with severe obesity--that is a body mass index of
equal to or more than 40--had onset of overweight in childhood.
So, successfully combatting the overweight epidemic in our
Nation as already alluded to will require the involvement of
many sectors and many levels of society, and although the
national initiatives that you have spoken about are very
important, they are not going to be sufficient by themselves.
We believe that community-based initiatives are critical for
reaching Americans where they live, where they work, where they
play, where they go to school. And we believe that State-level
programs are critical for supporting the community-based
programs.
So we work at all levels. The CDC has multiple approaches
to address obesity and its risk factors, including funding
State health departments, school-based programs, the national
media campaign, and community-based programs. There is the
``Steps to a Healthier U.S.'' cooperative agreement program
which is designed to promote programs that reduce the burden of
chronic disease and address those risk factors. In addition,
CDC funds 28 State health departments to prevent and reduce
obesity and its related chronic disease.
CDC also funds 23 State departments of education to
implement coordinated school health programs to help ensure
that students receive instruction in nutrition, physical
activity, and tobacco use.
You may have heard of the CDC's youth media campaign,
``VERB--It is What you Do.'' It is the largest national
multicultural campaign designed to increase levels of physical
activity among youth. The impact of this campaign has been
demonstrated. After 1 year of the campaign, the average 9- to
10-year-old in the Nation engaged in 34 percent more sessions
of free time physical activity when compared to children who
were unaware of VERB. This is a promising program that needs to
be continued.
Two recent initiatives tied to obesity are the Food and
Drug Administration Obesity Working Group, which, among other
things, is going to identify ways to help consumers lead
healthier lives through better nutrition; and of course, the
National Institutes of Health development of an Obesity
Research Task Force which will evolve into a strategic plan for
obesity research.
The Department and the U.S. Department of Agriculture will
host a National Obesity Prevention Conference this month to
address this public health concern. What we are trying to do is
learn from past and current research and identify steps that we
can take right now to prevent further increases in the
prevalence and severity of obesity.
We know that no one strategy, as has already been
mentioned, will be sufficient for promoting physical activity
and healthy eating. Our chances for success will be greatest if
we use multiple strategies to address multiple risk factors and
if we involve multiple sectors of society.
As Senator Harkin just mentioned, the Institute of Medicine
report has a lot of good things in it and underscores the
importance of these strategies.
So we are prepared to lead a national effort to combat the
overweight epidemic. We are committed to doing all we can do to
help the children in our Nation enjoy good health now and for a
lifetime.
Thank you for your attention, and I am happy to answer any
questions that you might have.
Senator Frist. Good. Thank you, Dr. Snider, and thank you
for your leadership. I have had the opportunity to visit the
CDC on this very topic, and I appreciate the real leadership
there.
[The prepared statement of Dr. Snider follows:]
Prepared Statement of Dixie E. Snider, Jr., M.D., MPH
Mr. Chairman, Members of the Committee, thank you for this
opportunity. I'm Dr. Dixie Snider, Acting Chief of Science at the
Centers for Disease Control and Prevention (CDC), which is part of the
U.S. Department of Health and Human Services (DHHS). Today, I'll
present an overview of the overweight epidemic among children and
adolescents and identify a number of DHHS initiatives and programs to
combat this epidemic.
Since 1980, the prevalence of overweight has more than doubled
among children and tripled among adolescents. The latest data available
from CDC shows that, between 1999 and 2002, 16 percent of children and
adolescents were overweight, and another 15 percent were at risk for
overweight. The increases in overweight among children and adolescents
cut across all regions of the Nation, ages, and racial and ethnic
groups; however, more African-American and Mexican-American youth are
overweight compared to white youth.
The primary concern of overweight and obesity is one of health and
not appearance. An estimated 400,000 adult deaths and $117 billion in
costs each year in the U.S. are associated with obesity. Most of the
disease associated with overweight and obesity occurs in adults, but
children who are overweight often develop risk factors for diseases
such as type 2 diabetes, high blood pressure, and elevated cholesterol
levels. Sixty percent of overweight children have at least one
additional risk factor for cardiovascular disease, and 25 percent have
two or more. Type 2 diabetes, which is strongly associated with
obesity, was virtually unknown in children and adolescents 10 years
ago; today, it accounts for almost 50 percent of new cases of diabetes
among youth in some communities. Childhood overweight is also
associated with discrimination, poor self-esteem, and depression.
Furthermore, overweight adolescents have a 70 percent chance of
becoming overweight or obese adults . . . and childhood overweight that
persists into adulthood is typically more severe than overweight or
obesity that develops during adulthood. For example, in the Bogalusa
Heart Study, 50 percent of those with severe obesity (a BMI >= 40) had
its onset in childhood.
Overweight and obesity represent a major long-term public health
crisis. If not reversed, the gains in life expectancy and quality of
life seen in recent decades will erode, and more health-related costs
will burden the Nation. Overweight and obesity result from an imbalance
between caloric intake and caloric expenditure. Many factors have
contributed to the unfavorable trends in physical activity and
nutrition that have fueled the obesity epidemic. Consequently, there
will be no silver bullet, no single change strategy to solve these
problems. Multiple strategies addressing multiple factors, such as
physical inactivity and excessive television viewing, will be needed.
The critical challenge is to help young people and their families adopt
healthy eating and physical activity behaviors. The Institute of
Medicine's recent report, Reducing Childhood Obesity: Health in the
Balance, underlines the importance of all of these strategies.
Addressing overweight and obesity is a top priority for DHHS
Secretary Thompson. I'll briefly describe seven key components of the
Department's comprehensive, multi-component approach to reduce
overweight and obesity.
First is providing strong, national leadership through President
Bush's Healthier U.S. initiative and Secretary Thompson's Steps to a
HealthierUS initiative, which promotes community programs that motivate
and enable responsible health choices. At the heart of this program
lies both personal responsibility for the choices Americans make and
social responsibility to ensure that policy makers support programs
that foster healthy behaviors and prevent disease. The Steps initiative
envisions a healthy, strong, U.S. population supported by a health care
system in which diseases are prevented when possible, controlled when
necessary, and treated when appropriate. The Steps Cooperative
Agreement Program is part of this initiative. This program aims to help
Americans live longer, better, and healthier lives by reducing the
burden of diabetes, obesity, and asthma and addressing three related
risk factors--physical inactivity, poor nutrition, and tobacco use. In
fiscal year 2003, $15 million was provided to 23 communities to support
innovative community-based programs that are proven effective in
preventing and controlling chronic diseases. In fiscal year 2004, $44
million will be used to increase funding to existing Steps communities,
fund new communities, and fund one or two national organizations to
enhance the capacity of Steps communities. Secretary Thompson announced
the awarding of these grants to 40 communities on September 28th.
President Bush and Secretary Thompson requested $125 million in the
Department's fiscal year 2005 budget for new and continuation grant
awards through the Steps initiative.
Second is developing and delivering clear, effective messages to
ensure that consumers have the information they need to improve their
health. Some of the key DHHS vehicles for delivering health messages to
the public include the Dietary Guidelines for Americans, jointly
developed with USDA every 5 years; the National Cancer Institute's 5 A
Day for Better Health Program to promote fruit and vegetable
consumption; and the President's Council on Physical Fitness and
Sports. Also, FDA is examining innovative ways to deal with the
increase in obesity and identify ways to help consumers lead healthier
lives through better nutrition, starting with reexamining the food
labeling Nutrition Facts Panel on most packaged foods. Further research
is necessary to establish how the food label can assist consumers to
make easier weight management decisions. But FDA is targeting food
label improvements in the areas of calories, serving sizes,
carbohydrates, and comparative labeling statements that will help
consumers make more informed and healthier food product choices in the
context of the total daily diet.
DHHS is communicating health messages directly to children through
``VERB,'' CDC's media campaign to increase physical activity among
``tweens,'' children aged 9 to 13. Campaign strategies include
multimedia advertising and marketing promotions using television,
radio, print, and Web sites; as well as contests and community events.
After 1 year, campaign impact has been demonstrated by reports of
increased free-time physical activity among the Nation's 10 million
tween girls, 8.6 million 9-10 year olds, and 6 million tweens from low-
to moderate-income households.
The third component is monitoring the problem and programs to
address the problem. CDC produces nationally representative data on the
prevalence of overweight and dietary and physical activity behaviors
among young people through its ongoing National Health and Nutrition
Examination Survey. In addition, CDC has surveillance systems in place
to collect national, State, and city data on height and weight,
physical activity, and diet among high school students, as well as data
on school physical activity and nutrition programs.
The fourth component is identifying and addressing research gaps.
The National Institutes of Health fund studies to develop and evaluate
interventions designed to prevent childhood overweight and promote
physical activity and healthy eating among young people. In addition,
CDC is developing a mechanism to quickly deploy staff into communities,
worksites and schools to help evaluate promising nutrition, physical
activity, and obesity prevention strategies.
The fifth component is synthesizing research findings to identify
effective policies and programs. CDC and NIH are involved in a number
of research synthesis activities to identify what works. For example,
CDC is working to translate the recommended strategies within the
physical activity and obesity chapters of the Guide to Community
Preventive Services into usable program guidelines and
recommendations--essentially providing a ``how-to'' guide for
practitioners to implement science-based interventions in their
communities, schools, and workplaces.
The sixth component is developing and disseminating research-based
tools to help schools and community-based organizations implement
effective policies and programs. These include, for example, CDC's
School Health Index for Physical Activity and Healthy Eating: A Self-
Assessment and Planning Tool; and Power of Choice, an after school
program jointly developed by FDA and the U.S. Department of Agriculture
(USDA) to help pre-teens make better food and physical activity
choices.
The seventh and final component is helping community and State
agencies and organizations implement effective programs. Last week
Secretary Thompson announced 22 grants to support communities
implementing the Steps to a HealthierUS initiative to help Americans
live longer, healthier lives. These grants support innovative,
community-based programs proven effective in reducing the burden of
diabetes, overweight, obesity and asthma and addressing risk factors
such as physical inactivity, poor nutrition and tobacco use in 40
communities including large and small urban, rural, and tribal areas.
The Secretary also announced the first Steps to a HealthierUS award to
a national organization--the YMCA to help build strong partnerships
with local communities and promote better health and prevent disease
among all Americans.
Fiscal year 2004 funding has enabled CDC to support obesity
prevention programs in a total of 28 States. Examples of State health
department activities that are helping children and adolescents include
encouraging restaurants to make fruit and vegetables more available;
improving lighting, sidewalks and crosswalks in neighborhoods as well
as cleaning up and reclaiming vacant lots for use as physical activity
and play areas; and training health care professionals to promote
behavior changes.
In addition, CDC provides funding to 23 States for the
implementation of school-based policies and programs to promote
physical activity and healthy eating among young people. State
education agencies are strengthening school health policies, improving
curricula, implementing professional development activities, and
involving families and communities.
CDC, NIH, FDA and other DHHS agencies will lead the Nation in
conducting the research necessary to learn more about strategies to
prevent overweight among children and adolescents. We know, however,
that there are no quick fixes when it comes to losing weight; it is
only through proper diet and physical activity that we can maintain and
improve our health. We know that no one strategy alone will be
sufficient and that our chances for success will be greater if we use
multiple strategies to address multiple factors that contribute to
caloric imbalance and if we involve multiple sectors of society at the
community, State, and national levels. DHHS is leading the national
effort to combat the obesity epidemic in children through a
comprehensive, multi-faceted, multi-level approach. We are committed to
doing all that we can to help our young people enjoy good health now
and for a lifetime.
I thank you for your interest and the opportunity to share this
information with you. I would be happy to answer any questions at this
time.
Senator Frist. Mr. Swann?
Mr. Swann. Thank you, Mr. Chairman.
I am going to ask that my statement be made part of the
record, and I will attempt to hit some of the highlights.
Senator Frist. Your entire statement will be made a part of
the record.
Mr. Swann. Thank you.
As a native Tennessean, Mr. Chairman, I do understand,
since my grandmother and grandfather wanted me to attend the
University of Tennessee, that anyone from the great Volunteer
State always has the Sugar Bowl on his mind as a part of the
SCC. So I understand that.
Senator Frist. The Bowls needed you 2 nights ago, by the
way.
Mr. Swann. Senator Dodd, it is good to see you again;
Senator Harkin, Senator Reed, it is a pleasure to be here
before you.
We at the President's Council on Physical Fitness and
Sports have recommended for quite some time that the children
of this Nation have 60 minutes of exercise each day for 5 or
more days each week to attain the health benefits of vigorous
physical activity. There are just far too many children who do
not have the opportunity to have that kind of physical
activity, for a variety of reasons which I will touch on just a
little bit later.
But considering that this committee is meeting to discuss
partnerships between various organizations to reach young kids
in the area of obesity, I want to highlight a few of the
partnerships that the President's Council on Physical Fitness
and Sports has maintained for a number of years.
Each year, the General Mills Champions Program awards 50
grants, $10,000 each, to children to be involved in community-
based groups to implement innovative programs to help youth
improve their nutrition and fitness behaviors. In the last 2
years, over 20,000 students competed in the 6 week activity
program and received Presidential recognition. General Mills is
now pledging to sponsor up to 50,000 youth a year.
The American Association of Clinical Endocrinologists
cosponsored a publication, ``Take the President's Challenge:
www.presidentschallenge.org,'' as a prescription for physicians
to hand out to children when they came in to visit their
doctors.
The Coca Cola Company has a Step With It Program,
partnering with the President's Challenge Program to encourage
school children to be active.
The Kellogg Company continues to promote physical activity
for very young children, age birth to 5, to parents and
caregivers through a publication cosponsored with the
President's Council on Physical Fitness and Sports called
``Kids in Action.''
Blue Cross and Blue Shield Association's ``Walking Works''
partnered with the President's Council on Physical Fitness and
Sports to produce and print a walking guide designed to help
Americans of all ages.
In addition, there are many other companies and programs
that we have worked with over the years. As a matter of fact,
tomorrow, Secretary Thompson will join me and Kay Coles James,
director of the Office of Personnel Management, to issue a
challenge to all Federal employees, the Healthier Feds Physical
Activity Challenge. So we are challenging all Federal agencies
to get involved and sign up on the President's challenge.
I spoke at the Mayo Clinic not too long ago. At the Mayo
Clinic in Rochester, MN, they have a phenomenal facility for
all of their employees that is free, for them to come to this
facility to work out and to engage in physical activity,
because they believe in the importance of physical activity.
In about 2 weeks, I will be in Omaha, NB, where the Union
Pacific Railroad Company is going to open up and highlight
their new office complex, over 1 million square feet. They have
taken the time to include a very extensive wellness program
within that facility for all of their employees to be able to
come in, to get physical activity at various times of the day
when it is more convenient for them, on site, to encourage that
kind of physical activity.
When we talk about obesity as it relates to children, our
children have and always will continue to learn by example. If
their parents are not physically active, if they do not
encourage their children to be active, regardless of what we
teach them or attempt to teach them in school, these children
will not be physically active.
So it is important that we make sure that our adults get
the same message and have the same opportunities that our
children have to be more physically active. And then we have to
have that continuing education program with our children.
We spend $117 billion a year on obesity and obesity-related
illnesses and diseases. We spend $139 billion on diabetes. That
is $250 billion a year that we spend in preventable areas
through physical activity. Not all of it is for bad reasons in
terms of why we have gotten to this point. Obesity just did not
jump up. Indeed, there are people who are thin, who look
absolutely wonderful, whose health is probably not as good as
someone who is overweight, because they do not exercise. And if
you are looking for a reason, part of it is our own success--
the innovation of the computer, the Internet, the games that we
do, the technology--we no longer have as much of a need for a
large labor force. Our automotive industry, our industrial
segment, goes to robotics, so there is not that need.
And when is the last time you actually saw a man digging a
ditch? I will tell you when you saw him digging a ditch. There
was one guy sitting on the backhoe and three guys pointing to
where he should dig. That was the last time you saw a guy
digging a ditch.
All of those things are good. What we are really talking
about here is an overwhelming lifestyle change--a lifestyle
change. We in America love our conveniences. We can have the
greatest shop, the greatest store; it will be five blocks down
the street--and we will get in our car, and we will drive
there, and we will go through the drive-through and get our cup
of Starbucks coffee or anything else we want, as opposed to
walking there.
And Senator Harkin, when was the last time you went by a
school and saw a bicycle rack full of bicycles? We do not see
it. And it is not necessarily for bad reasons. We feel
sometimes that we need to drive our kids to school, we need to
make sure they get there safely. We want them to be safe after
school and not be wandering around, influenced by any bad
segments of our society.
So what do we have to do? We have to create opportunities
for everybody to participate in areas of physical activity.
Sport is a wonderful way of doing it, because you get all the
benefits while you play a game. But in many of our schools, the
only people who participate in sports are the best athletes,
because that is all the school can afford.
We need to still find opportunities for all children to
participate. My oldest brother is five-foot-six, he is 135
pounds, and he is a dentist. He loved to play basketball when
he was in high school, so he played on the ``D'' basketball
team because he was one of the small guys; and he competed in
track. Most high schools today only have a junior varsity and
the varsity team, so if you are not the best athlete, you do
not get a chance to play.
We need to make sure that we create those opportunities for
our kids to have that balance. And it is a balance--it is
nutrition, and it is physical activity.
I will close by giving you one example. A college football
player, offensive or defensive lineman, who weighs anywhere in
Division 1-A football between 250 and 310 pounds will eat in 1
day 6,000 calories. That is a huge amount of food. But look at
all that that young man is doing in the course of a day--the
weight training, the running, getting around campus. Six
thousand calories for some of those athletes is barely keeping
that weight on because of the high level of physical activity.
There is a balance. If you take in 1,500 calories a day and
you only get physical activity of 1,000 calories a day, your
net gain is 500 calories a day, and you will gain weight. It is
very simple. We do not need a magic pill to understand that
there is a balance to what we do, and we need to find a way to
make sure that our children are eating well, eating the proper
foods, getting the right amount of physical activity to balance
what goes in, so that if they are going to live longer, and
when they do live longer, it will be a better quality of life.
Thank you.
[The prepared statement of Mr. Swann follows:]
Prepared Statement of Lynn C. Swann
In a Presidential Proclamation earlier this year (May 8, 2004),
President George W. Bush stated,
``By exercising regularly and participating in sports, we can
improve our health, set a positive example for our children, and help
build a stronger future for our country.''
In the last century, our Nation made striking advances in public
health. The chief enemy was infectious disease, such as tuberculosis,
pneumonia, bacterial infections, and diseases caused by contaminated
water and food.
By the end of the 20th century, we could look back with pride at
the enormous victories we achieved by creating drugs and adopting
hygiene practices that have dramatically reduced the gravest threats to
public health.
At the beginning of the 21st century, our Nation faces a deadly
health crisis with the potential to do great damage from a cause that
until recently has not been a major threat. We are in the midst of an
obesity epidemic caused by poor diet and sedentary lifestyles. We are
eating too much and moving too little.
The latest figures released recently by the Centers for Disease
Control and Prevention show that 400,000 people a year--almost 1,100
Americans a day--die from conditions related to physical inactivity
combined with poor diet. Only smoking kills more people--435,000 people
a year. The gap is closing fast. However, if the numbers keep growing
at the same rate as they did during the past decade, physical
inactivity and poor diet might overtake smoking as the leading cause of
preventable death in the United States.
Sixty-four percent--that's two thirds of American adults--are
overweight or obese.
As Chairman of the Council, I feel especially responsible for the
health of millions of our children. Fifteen percent of our children and
adolescents are overweight--9 million young people. The percentage is
even higher for African American, Hispanic, and Native American
children--over 20 percent. Ten percent of our little ones age 2 to 5
are overweight. Type 2 diabetes and cardiovascular risk factors such as
high blood pressure are showing up in young children.
Only about one-half of U.S. young people (ages 12-21 years)
regularly participate in vigorous physical activity. According to a
study done by the National Association of Sports and Physical Education
(NASPE), children should engage in at least 60 minutes of physical
activity daily and should not be sedentary for more than 60 minutes at
a time except when sleeping. On average, children in the U.S. watch 18
hours of TV a week. As Secretary Thompson says, ``We need to get our
children away from the Play Station and out on the playground''.
What if there were a drug that helped reduce the risk of developing
or dying from heart disease, stroke, high blood pressure, type 2
diabetes, colon cancer, osteoporosis, arthritis, depression and
anxiety? We'd probably demand that it be put in the public water
supply. Everyone would clamor to have access to this magic pill.
Let me tell you that such a remedy already exists, one that won't
take years of research and development or clinical trials. It has no
undesirable side effects. It has no costs except commitment and
determination. That medical miracle is daily physical activity.
HHS studies and reports show that if adults would engage in only 30
minutes of moderate physical activity a day, such as brisk walking, on
5 or more days a week, it would decrease the risk of developing or
dying from cardiovascular disease, type 2 diabetes, and some cancers--
such as colon cancer--as well as helping to prevent osteoporosis,
arthritis, anxiety and depression.
But children are not small adults--they need more activity to be
healthy, at least 60 minutes on most days of the week. There must be a
concerted effort by parents, schools and communities to make sure that
children have the time and opportunity to gain the health benefits of
moving at least 60 minutes throughout the day.
Physical activity helps maintain a healthy weight. There's a
concept called the ``energy equation.'' We need to expend as many
calories by physical activity as we take in.
As an athlete myself, I love to work out and play sports. But
children don't have to play sports to be active. Just walking the dog,
helping with household chores, playing tag in the yard--any activities
that cause children to move the large muscles of their bodies--afford
the health benefits of regular physical activity. Parents can help by
monitoring TV and computer time and making family time active time so
the whole family becomes healthier. If you are age 18 or older, it
takes at least 30 minutes of physical activity a day to gain health
benefits. And you don't have to do it all at once--you can accumulate
30 minutes of activity throughout the day in 5, 10 or 15-minute
increments. But remember, children and teens up to age 17 need at least
60 minutes of movement on most days of the week.
I applaud this committee for exploring the ways that public private
partnerships can be effective in countering the growing obesity
epidemic threatening the health of our children.
I'm proud to say that the President's Council on Physical Fitness
and Sports is on the cutting edge in that area. We are already working
closely with partners in corporations and business, with non-profit
organizations, with health care providers and insurers, educators,
fitness and sports professionals, and other public agencies to
encourage Americans to be physically active every day for health.
Let me highlight some of our public-private partnerships:
Each year, the General Mills Champions Program awards 50 grants of
$10,000 each to community-based groups that implement innovative
programs to help youth improve their nutrition and fitness behaviors.
To celebrate National Physical Fitness and Sports Month in May 2003 and
May 2004, General Mills sponsored the President's Challenge awards for
all Minneapolis schools. In a 2-year period, over 20,000 students
competed in the 6-week active lifestyle program and received
Presidential recognition. General Mills is now pledging to sponsor up
to 50,000 youth.
The Coca Cola Company's ``Step With It'' program partnered with the
President's Challenge program to encourage school children to be
active. Coca Cola provided ``stepometers''--small pedometers that track
the number of steps taken in a typical day to encourage participants to
increase their daily walking and overall activity to maintain good
health, while simultaneously fulfilling the requirements for the
Presidential Active Lifestyle Awards (PALA) Program and awards. Coca
Cola subsidizes the award and certificate for each child who completes
the 6 week program.
The Burger King Corporation sponsored President's Challenge awards
during spring 2004. In this initiative, 206 schools nationwide received
awards, and 66,000 students had an opportunity to receive presidential
recognition for becoming and staying more fit and active. The
sponsorship allowed parents, teachers and /or students to nominate
their school for the awards as recognition of existing physical
education programs.
Another partner, Wheaties, provided equipment such as soccer balls,
footballs, jump ropes, etc. to each school selected by the Council as a
State Champion award winner, part of the President's Challenge program.
Each year, the PCPFS honors 3 schools with the State Champion award.
Based on enrollment size, the 3 schools within each State that have the
highest Presidential Physical Fitness Award winners receive this
special recognition. Wheaties encouraged each winning school to create
and submit a poster depicting fit and active lifestyles. Wheaties
selects a winning poster for use as a backdrop for the next year's
program. A poster is sent to each State Champion school. In addition, 3
schools based on enrollment size receive $5,000 grants for their
physical education department. One million Wheaties' boxes promoted and
encouraged all Americans to adopt and maintain an active lifestyle
while earning presidential recognition for their efforts.
The Kellogg Company is promoting physical activity for very young
children (birth to age 5) to parents and caregivers through a
publication co-sponsored with the President's Council on Physical
Fitness and Sports, ``Kids in Action.'' The Kellogg Company is now
partnering with the President's Council and the National Association of
Sport and Physical Education (NASPE) to bring this important
information to child care providers in day care centers as well as to
parents and caregivers at home. The Kellogg Company produces, prints
and distributes ``Kids in Action'' free of charge, and the Council
assists in promoting physical activity for young children through
cooperative media outreach and events and distribution of ``Kids in
Action'' to the public.
The American Association of Clinical Endocrinologists co-sponsored
a publication, ``Rx: Take the President's Challenge:
www.presidentschallenge.org'', a prescription for physicians to give to
youth during school visits, when the doctors give a presentation about
physical activity and sound nutrition and promote
www.presidentschallenge.org to students, teachers, and parents.
The Blue Cross Blue Shield Association's (BCBSA) ``Walking Works''
partnered with the President's Council on Physical Fitness and Sports
to produce and print a walking guide designed to help Americans of all
ages set their own benchmarks and achieve personal walking goals.
Walking Works is a consumer education program developed to motivate
BCBSA plan members and their families to integrate walking into every
day, live healthier lives, and reduce the likelihood of costly health
problems down the road.
Members of Congress and their staffs were asked to walk for health
by signing up for the Congressional Challenge, ``Walking Works''
program, in partnership with Blue Cross Blue Shield. During this 6-week
challenge, staff members worked toward a Presidential Active Lifestyle
Award (PALA) by logging on to www.presidentschallenge.org.
Tomorrow (Wednesday, October 6, 2004) Secretary Tommy Thompson will
join me and Kay Coles James, Director of the Office of Personnel
Management, to issue a challenge to all Federal employees, the
HealthierFeds Physical Activity Challenge. We are challenging the
Federal agencies to compete with each other to earn Presidential awards
and to be national role models for active lifestyles.
Right now we have great leaders as role models--a President in the
White House, a Secretary of Health and Human Services, and a U.S.
Surgeon General who all advocate for prevention and healthy lifestyles.
They walk the talk and practice what they preach. President Bush is in
the top 1 percent of health statistics for men his age and in the top 3
percent of men over age 30. Secretary Tommy Thompson lost 15 pounds. He
walks around the HHS building and encourages employees to stop smoking.
He wears a pedometer and exercises regularly. Surgeon General Dr.
Richard Carmona speaks around the Nation to school children and others
stressing the health benefits of physical activity, nutrition,
prevention, and other healthy behaviors.
I know that each and every Member of Congress wants to help our
Nation become strong and healthy, ready to meet any challenge. You can
be justly proud of the support given to research for new drugs and
medical treatments for disease. But think of all the money we could
save on health care if we begin to give equal emphasis to prevention
now.
The time is right for Congress to look at innovative ways to reduce
staggering health care costs. Sometimes we need to shift our
perspective to move in a new direction. Our entire health care system
is organized around treating diseases after they occur, not preventing
them before they occur. We need a paradigm shift that places prevention
at the center of our health priorities. We need to focus not only on
the people who are already sick with chronic disease but also on the
generation that is growing up, the kids that are overweight at age 2 or
3, and ill with type 2 diabetes and high blood pressure by the time
they are 8 years old.
As you consider what Congress and the Department of Health and
Human Services can do to promote the health of the Nation, remember
that 40 years ago, we were only beginning to hear the message about the
dangers of tobacco use. It's taken that long to change the way people
think about smoking.
We can't afford to wait 40 years before people begin to take care
of their health by stressing prevention. Today, we spend $117 billion
annually on conditions related to obesity and $132 billion on type 2
diabetes. That's about $250 billion a year. What if we had that much
money to build parks, playgrounds, and playing fields? We might begin
to reverse the alarming health trends we are seeing in our children.
What if we could put some of that money into preventive medicine--for
sidewalks, bike paths, playgrounds, sports facilities, after school
programs, and youth recreation centers? If we want to see a bright and
healthy future, we must change the way we think about health priorities
and focus on prevention.
The Federal Government needs to stimulate all levels of
government--Federal, State, and local--to join with us and with
partners in the private sector to attack the obesity epidemic and its
attendant health problems. Please consider how the Executive and
Legislative branches of the Federal Government can work together with
corporations, organizations, educators, health care providers, States,
communities, families and individuals to make healthy choices.
We need our government to stand squarely behind initiatives and
interventions to stress and encourage all Americans to be physically
active every day, to eat a nutritious diet, to get preventive
screenings, and to avoid risky behaviors. These are the four pillars of
the President's HealthierU.S. initiative. We need to ask ourselves,
``What help and incentives are needed to make people take these steps
toward better health to improve their lives? How can we provide them?''
It only takes small steps. It's important to spread that message.
If we can encourage people to cut their calorie intake by 100 calories
a day; to walk for 30 minutes 5 days a week, for example, we would
begin to transform the health of the Nation. We must give our children
the education and tools they need to make healthy nutritional choices.
We must monitor their eating at home and at school. We must make time
and opportunities for them to be active at 60 minutes on most days of
the week. It's the small steps that count--small steps in the
individual lives of many would reap dramatic benefits for the Nation as
a whole, saving not millions but billions of dollars.
I urge you never to underestimate the power you have as
legislators. Working together, we have the ability to promote the
health of our fellow citizens and our Nation. When you consider
legislation on health, environment, transportation, and education--
remember that you are dealing with the lives and well being of the
American people for years to come. We are talking about our own
children and grandchildren. May the mark that we, as public servants,
leave on those we touch be one that nurtures and enhances the health
and overall well-being of this great Nation we serve.
Thank you for inviting me to testify on this most important topic.
At this time I would be happy to respond to any questions.
Senator Frist. Thank you. I thank both of you. Very well
said.
Senator Reed?
Senator Reed. Thank you, Mr. Chairman, and thank you,
gentlemen, for excellent testimony.
This is an extraordinary problem. We are on the leading
edge of a real crisis. It is an epidemic now; it will be a
crisis in a few years.
As Senator Harkin pointed out, we stand on the verge of
doing something that I think all of us thought would be
impossible, which is reversing the increase in life span of the
American public. That has been the measure of our public health
progress over 200 years, each rapidly increasing the life span.
And we are going to turn that around, perhaps.
The other point is that it is all preventable, or most of
it is preventable. And the huge costs--Mr. Swann pointed out
the costs today--we are trying desperately to fund our health
care system, and if these costs hit us, it might literally
swamp the boat.
So again, Mr. Chairman, I think this is a very, very timely
and important hearing.
There is one other point I would make which echoes what the
witnesses said. This is not a medical problem as much as a
cultural and lifestyle problem, because the dynamics are not
just physiology--it is advertising, it is access to food, it is
lack of physical activity--all the things that the witnesses
have pointed out very well.
Dr. Snider, in the Children's Health Act of 2000, we direct
CDC to work with HRSA to develop and implement a program
designed to educate health professionals about identifying at-
risk children for obesity and also educating and informing
these children and families. What has CDC done to follow up on
this initiative, and what is the status, if you could, of that
program?
Dr. Snider. CDC has a number of programs ongoing right now.
I mentioned several of them that relate to working with States,
working with schools, working directly with community
organizations and media campaigns. But I appreciate the
opportunity to fill in the gap on the other initiatives.
We are working with professional societies to increase not
only the awareness--because as you know, increasing awareness
does not necessarily translate into taking action--but to
increase their knowledge of what works. And this is where I
think we are in a particularly transitional situation with
regard to dealing with this epidemic. As the IOM said, we need
to apply the best available science to this emerging problem.
We cannot afford to wait.
At the same time, we know that we need to have more
definitive science and the best possible science. So one of the
questions that we face in working with these professional
associations is what works. And some of the colleagues who will
follow on the next panel may have some comments to make, but I
think that we can learn, as has been alluded to, what has
worked with other counseling as it relates to tobacco
cessation, as it relates to HIV and STD prevention and so
forth. The key is what are the kinds of approaches that health
professionals can take that will result in a change in
behavior, not just inform the patient.
I think we have some promising results in working with the
professional societies, but we still have a way to go to try to
find out what are really the best ways to effect changes in
personal behavior.
So we continue to work with professional societies on this
problem to try to increase awareness, but I think there is
still a challenge for developing better interventions.
Senator Reed. Thank you.
In your statement, Dr. Snider, you alluded to the numbers
that CDC is collecting about nutrition and physical activity in
high school and also the National Health and Nutrition
Examination Survey. Can you give us some details? You said it
is a pervasive problem, but are there geographic variations or
economic status variations or anything that should be
highlighted? You did mention the disparity between the minority
obesity levels in children and others.
Dr. Snider. I did not bring those tables with me. We
certainly could provide them to the committee. We have
published those. As I said, they are from the NHANES study, for
example, and youth risk behavioral surveillance also provides
information.
I think the major take-away point, though, is that although
there are variations around the country and among different
groups--clearly, lower-income have a bigger problem with
obesity or overweight than higher-income; Mexican American
boys, African American girls--the main take-away message is
that there is no group that is immune. I mean, it is pervasive
throughout the population. So there are no target groups to go
to. This is a problem of national scope.
Senator Reed. Thank you.
Mr. Swann, if I could----
Senator Frist. Let's do one more question.
Senator Reed. One more question. Thank you.
Again, Mr. Swann, thank you for your excellent testimony.
You are all over the country, and you are inspiring, not only
through your career but your present activities, children to be
physically active. What are the two or three most important
things we can do?
Dr. Snider. While we wait on the best science, I think we
ought to just start being active. I will give you an example. I
have five acres of land, and I needed to clear it. I sat around
every morning drinking a cup of coffee, thinking, well, do I
need a backhoe, do I need a chainsaw, how big a chainsaw--what
equipment do I need? I did this for about a month. If I had
just put on a pair of sneakers and a pair of bluejeans and a t-
shirt and gone out into the back yard, I would have cleared the
five acres and not had to worry about it.
So while we are in the process of thinking about what we
should do, we should do very simple things. We should get out
and walk as a family. We should have programs. There are
programs on presidentschallenge.org, a website for the
President's Council, that highlight partnerships that we have
and links to other organizations to institute programs. If a
school does not have a physical fitness program or a physical
education teacher, any teacher in a school can implement the
President's Challenge for the kids in that school.
So I think if we simply get active and do something--it
does not have to be high-tech--but get active doing a variety
of things and understand that we are not trying to create
another pro football player, it is not an effort to create an
Olympian but an effort to create a healthier young person,
adult, and senior citizen.
Senator Reed. Thank you very much.
Thank you, Mr. Chairman.
Senator Frist. Thank you, Senator Reed.
Senator Dodd?
Senator Dodd. Thank you, Mr. Chairman.
I am going to ask consent, Mr. Chairman--you and I and a
number of others sent a letter back in March to GAO requesting
that they do a study to examine Federal and State activities
designed to prevent and treat obesity among children and
adolescents. They are in the process of doing that study, but I
thought it might be worthwhile for our colleagues to be aware
that that process is under way.
[Letter from Senators Dodd and Frist was not available at
time of print.]
Senator Dodd. I have just a couple of quick questions, if I
can. Again, thank you both. It is good to see you again, and
welcome back to the Congress.
Dr. Snider, you mentioned the VERB campaign as part of
CDC's efforts to prevent obesity in children ages 9 through 12.
Yet this administration has zeroed out the funding for that
program. I wonder if you might give us some other ideas about
what CDC can do to make sure that children in this age group
are going to receive a positive message about activity?
Dr. Snider. Well, we were encouraged by the VERB campaign.
We were encouraged by the results that I mentioned to you. We
were encouraged after the release of the IOM report and the
positive statements that the Secretary made about the VERB
campaign.
One of the things I did not emphasize----
Senator Dodd. Was any reason given for why they zeroed out
the program?
Dr. Snider [continuing]. No, I do not think any particular
reason has been given, and we do not have a fiscal year 2005
budget yet, so I do not want to make any assumptions about----
Senator Dodd. Let us use the forum here--would you like to
see a little funding put in that program? Go ahead, Doctor,
jump out there.
[Laughter.]
Dr. Snider. Is this a professional judgment?
Senator Dodd. Of course, it is.
Dr. Snider. Yes, I think we would like to see the program
continued. From talking to my colleagues here, it is clear--
this is one of those areas where we have created a number of
partnerships, which is one of the things that this hearing is
about, and I did not have an opportunity to talk about all the
partnerships we established with VIACOM, ABC, Time-Warner,
sports league partnerships, NFL, National Hockey League, for
example, manufacturers, Huffy Sports, Wilson's Sporting, and
the YMCA.
So these partnerships really were extremely important, and
I think one of the things that we would like to do is continue
on, see whether we can have a sustained effect on a larger
population. The population that responded the most was girls.
Can we modify the campaign a little bit working with the media
companies so that we have an impact on boys as well? Can we
have an impact on a larger range of age groups beyond the
``'teens'' that VERB is focused on, the 9 to 13-year-olds?
So I think there is a lot that could be done with mass
media. We know that mass media works. We know that companies
spend huge amounts of money advertising. Food companies spend
huge amounts of money advertising food to children, and it must
work; otherwise, they would not keep putting money into it. And
we think this counter-advertising, if you will, toward
promoting physical activity deserves an investment and a
critical evaluation. We do not want you to put taxpayer money
down the tubes, but given the results we have gotten, we think
it deserves a chance.
Senator Dodd. Let me ask you this. We know as a result of
studies that have been done, and certainly the guidelines that
CDC has recommended, that daily physical exercise is a must.
Lynn Swann talked about it. Yet we know that fewer than 6
percent of senior high schools require any kind of daily
physical exercise.
We are here trying to determine policy issues. Senator
Harkin mentioned, I think appropriately so, the ``No Child Left
Behind Act,'' the education of all children.
What policy recommendations would the CDC make regarding
the Federal Government's commitment to elementary and secondary
education to require some greater degree of participation in
physical exercise than we are presently seeing?
Dr. Snider. Well, CDC's position is that--first of all, as
you know, the school policies around physical activity are set
at the local level--but our recommendations to the States and
the communities are----
Senator Dodd. With Title I money--we provide a lot of money
to schools.
Dr. Snider [continuing]. Our recommendations are that they
have physical education programs in all the schools.
Senator Dodd. But you realize, of course, that they are
strapped. I mean, these schools are----
Dr. Snider. They are strapped, and they are under a lot of
pressure to deliver academic performance. I think this is one
of those areas where we need to get out there and roll up our
sleeves with the educators and figure out how we can help them
achieve all of their other objectives related to academic
achievement, but still keep our kids physically active.
Senator Dodd [continuing]. Good. Do you have any
disagreement with Lynn Swann's numbers regarding the cost of
obesity today--the statistics he cited about the----
Dr. Snider. The $117 billion, for example?
Senator Dodd [continuing]. And the $250 billion. Are those
pretty accurate numbers, do you think?
Dr. Snider. Yes, sir.
Senator Dodd. So what we are talking about here--I mean,
what we contribute to elementary and secondary education is a
fraction of that cost, and the issue is whether or not we are
going to provide some real resources back, particularly--as we
know and as you point out, poorer kids have a tendency to
suffer from this problem to a greater extent than more affluent
children. That is a fact.
Dr. Snider. Yes; for a whole variety of reasons.
Senator Dodd. So that obviously, poor school districts that
are struggling to provide science teachers and math teachers
and the like are also strapped when it comes to adding programs
involving fields of education.
What we are looking for is not only to get some
recommendations but some meat behind this, some real resources
that would make it possible for these poor districts to be able
to include as part of their daily curriculum physical exercise,
knowing the cost and knowing the implications of it.
Dr. Snider. There is no question but that there are
economic factors that are driving the inability of certain
schools to offer the kind of physical education programs that
many of us used to get routinely when we were growing up.
Senator Dodd. Let me ask one last question if I can. The
IOM and the CDC both talked about the importance of sending
clear messages to kids. It would seem that partnerships with
Coca Cola and Burger King would send the wrong message to kids
in some ways. Maybe you want to address this. I am not trying
to pick on two particular corporations, but as Senator Harkin
has pointed out, the quantity of sugar in these products--these
are not exactly the kinds of foods that you would be
recommending that children consume with any great consistency,
and partnerships with them create, it would seem to me, a
contradictory message.
Mr. Swann. Well, it does not create a contradictory
message. I think the message is that if children are going to
eat something that has a higher sugar content, they have got to
offset it by a certain amount of physical activity. For
instance, we are not recommending that you eat 15 teaspoons of
sugar a day, but if you have the intake of something that is
3,000 calories, do you have a certain amount of physical
activity to balance that out, and is that a part of your
regular day.
You also have to have as part of that balance an
educational program so that kids understand what they are
eating, so they are not taking in too much or a high quantity
of things that are not good for them. So you should not have a
20-ounce Coke every day, or two 20-ounce Cokes out of the
machine. I think the obligation and the responsibility of the
food companies is to deliver a message of education that says
this is what a nutritious diet is all about, this is what a
balanced meal is all about.
Senator Dodd. Have you ever seen Coca Cola or Burger King--
we will use those two; there are others--have you ever seen
them recommend only drink one Coke a day, or one Coke every 2
days?
Dr. Snider. Well, I think certainly, Senator, what they
recommend in terms of physical activity is to balance what they
intake with physical activity and look at a proper balance in
terms of a diet. I cannot dictate to them what they do in terms
of their advertising and things of that nature, but our mandate
is to ask kids to be more physically active. Our mandate is to
have kids have a better understanding and knowledge of what is
nutritious and healthier for them.
We create partnerships with companies who are willing to
deliver that particular message. I do not think it is any
different in this particular perspective from the mandates made
on cigarette or tobacco companies to say you must educate
people. Certainly people would say, well, why are you asking
tobacco companies to educate people about the harms and the
negative factors of cigarette smoking. They have done so
because they have been forced to do so. Food companies are
taking a proactive position in terms of trying to deliver a
more positive message about balanced nutrition and physical
activity.
Senator Dodd. All right. I will stop there. My colleagues
probably have some additional questions. I just wanted to raise
with you the possibility of why we do not encourage in the
insurance industry--I think your point about adults is
important and setting examples--but why we do not reward adults
through reduced premium costs, for instance, on health care for
those who do engage in physical activity, or give businesses
breaks in terms of premium costs when they have physical
fitness programs, allow time for it.
Rewarding adult behavior by reducing the cost of health
insurance given the greater likelihood they are not going to
need it seems to me to be one of the worthwhile ways to
promote--nothing will get people's attention more than reducing
the cost of a health care premium.
Mr. Swann. Senator Dodd, what you have just said are
recommendations and things that I have brought up in Council
meetings on a number of occasions in terms of trying to
approach the insurance industry with those kinds of things. I
am not allowed to approach the industry to make those kinds of
suggestions.
If I were allowed to approach----
Senator Dodd. What do you mean, you are not allowed?
Mr. Swann [continuing]. I am not allowed as chairman of the
President's Council to go to the companies and make these kinds
of suggestions. I have to sit and wait for them to come to me.
Those are the rules of government, if you will, for our
particular agency, Senator.
For instance, if I could, I would suggest to all the
companies that manufacture electronic games at least a 20 or 30
second spot that you cannot forward past, you cannot erase,
that would ask each child every time they turn on that game:
Have you gotten your 60 minutes of physical activity today?
There would be a suggestion every time they turn that game on--
have you exercised today? What have you done?
But again, in my position, I am not allowed as chairman of
the President's Council to walk up to those companies, to knock
on their door and say, ``I have an idea for you. Can we do
this?''
Senator Dodd. That is a subject for another hearing, I
guess, to find out why that exists.
Thank you.
Senator Alexander [presiding]. I believe Senator Harkin was
next.
Dr. Snider. Senator, if I could just add, though, you gave
us some money this past year----
Senator Dodd. Not me, personally.
Dr. Snider [continuing]. Which we have invested in health
promotion in the workplace and also in establishing two centers
for excellence in health promotion economics. It is our hope
that through those research projects, we will generate the kind
of data that will convince companies and insurance providers
that it is cost-effective to invest in these kinds of things.
Senator Alexander. Senator Harkin?
Senator Harkin. Thank you, Mr. Chairman.
Again, I want to thank you both for your leadership and for
being here today.
Is it true, Mr. Swann, that you were actually in dance
class when you were in seventh grade?
Mr. Swann. I took about 14 years of dance class, that is
correct.
Senator Harkin. Well, I daresay that if you were in school
today, that dance class would not be there.
Mr. Swann. Those classes were not in school, sir. I always
took them after school.
Senator Harkin. Oh. I thought it was in school.
Mr. Swann. No.
Senator Harkin. It was after school. Well, they would not
be in school because they are being cut out because of time
constraints and money constraints and things like that.
I was also remiss in my earlier statement--I should have
mentioned the fact that our Secretary of Health and Human
Services, Secretary Tommy Thompson, has been one of the great
leaders in this area of physical fitness. He has done a superb
job, and I just want to publicly acknowledge one more time his
great leadership in this whole area of physical fitness and
well-being, in a lot of different areas.
The STEPS program is a great program. Now, again, it is one
of those things that is starting small, but it needs to be
expanded out. Secretary Thompson has done a great job in
promoting that.
One of the other things--and I think I talked with you
about this, Mr. Leader, at one time--that Secretary Thompson
has placed signs by all the elevators at HHS--I saw them down
there--that if you just go a little bit to the right, there are
stairs there, and if you climb the stairs, you burn--I have
forgotten how many calories it was, but I thought that was
pretty darned neat.
So I have taken it upon myself now to start climbing stairs
instead of taking the elevator, and it is amazing--you really
do not lose that much time, but what it does for you, just
climbing stairs every day, is amazing.
Mr. Swann, when you go out to see Union Pacific, would you
stop in DesMoines and see Townsend Engineering and also go and
see Grundy Center High School in Iowa? The reason I say that to
you is because I take a little exception with your focus on
sports. Now, I appreciate sports, but a lot of kids do not play
sports, whether A, B, C, D--they just do not.
But what Grundy Center High School has done with the Carol
White Physical Education Program, the PEP program--and by the
way, Senator Stevens has been very supportive of getting more
money for the Carol White PEP program--what they do in the high
school is every kid in that high school has a physical fitness
routine. They do not play sports, but they have something they
do every week. They take every kid in the high school when they
first come to high school, they get their body mass index, they
set them up on a routine, it is all computerized, and they
track them as they go through high school--every kid, even kids
with disabilities, gets exercise. They do not play sports, but
they have an exercise routine for every kid in that school.
So I do not want us just to focus on sports. There are
other things you can do in elementary school, middle school and
high school. And by the way, now people come from around the
United States to Grundy Center High School to see what they did
there and how they can do it in their own schools. I know a lot
of middle schools are doing the same thing.
So I hope you will think about the broader context and not
just sports.
Senator Alexander. Yes, Mr. Swann.
Mr. Swann. I would like to say that I understand that
perfectly. Normally, when I speak to a group about physical
activity, I speak to them for about 40 minutes or longer, and
that is one of the areas I cover.
The President's Council on Physical Fitness and Sports has
been very proactive and I think is on the cutting edge in terms
of what you are just now discussing. At our website, for
instance--which is free, anybody can use it, any company can
use it, any group can use it, and sign on--it will track you
for the rest of your life and the amount of physical activity
you are doing if you just input the information in there. And
on that physical activity, we have over 100 things listed as
physical activity. Yes, there are the traditional things in
terms of sports, but we even have dart throwing, if you will;
we have housework, we have gardening, walking. It is all the
things that you are talking about. Not every child plays a
sport.
Indeed, most of us who have played a sport in high school,
by the time we graduate from college and get a job and go on to
some professional career, if it does not involve sports, we are
no longer on the team. So part of the education has to be
making the priority to get some other kind of physical
activity.
So I agree with you 100 percent that we have to encourage
them to do other things than just be on the team.
Senator Harkin. Yes. If they do it all the way through
school, by the time they graduate, it has become a part of
their lifestyle--keeping physically fit, tracking their body
mass index, tracking their cholesterol and blood pressure.
Mr. Swann. Correct.
Senator Harkin. It becomes a part of their lifestyle--but
you have got to start with these kids early.
Mr. Chairman, I just want to say one other thing. I am all
for personal responsibility. I am all for it. But again, I will
take a little exception with you--you said it does not send
mixed signals when we put vending machines in schools and
things like that.
What level of personal responsibility are we asking in a
child of 8 years old or 10 years old or 12 years old when they
are bombarded at the earliest possible time in their lives with
things like this--the Oreo Cookie Counting book; you learn to
count by counting Oreo cookies. And you have--well, actually
this is not bad; Cheerios is really pretty good, as long as
they are not sugared-up--but you have the Fruit Loops Counting
Book, the Goldfish Counting Book, the M & M's Counting Board
Book. These are for kids who are learning how to count. It is
embedded in their brains that these are good for them.
Then, the other thing that we see happening with kids is
that they are taking all the kids' cartoon characters and
putting them on all this junk food. So you have SpongeBob
SquarePants. Kids love SpongeBob. He is now on Cheese Nips with
Elmo and Cookie Monster and on and on and on--all these
characters are on every--you do not see these characters on
fruits and vegetables. Why don't they have SpongeBob
SquarePants on spinach or broccoli--how about apples and pears
and oranges? No. It is on all this stuff.
I know this is not what you are saying, but almost what is
coming through is: Kids, you can eat all the junk food you
want; all you have to do is work it off.
I am sorry. I know that is probably not what you are
saying----
Mr. Swann. It is definitely not what I am saying.
Senator Harkin [continuing]. I know it is not. But I am
sorry to have that interpretation. It is not enough just to
work it off. I am all for personal responsibility. I am all for
parents setting a good example. But this is an epidemic, folks.
This is not something where we can just sit around and say
``personal responsibility.''
I am all for personal responsibility, but when you have an
epidemic, there is a governmental responsibility for us to do
something, to step in and start efforts at stopping it. Yes,
personal responsibility, family responsibility, community
responsibility, but there has to be some responsibility to get
to these kids early on in life to get them started on a healthy
program. And this kind of stuff simply does not do it. You are
getting these kids early on in life, and they are getting these
mixed messages about what is good for them and what is not good
for them.
That is why I think this has got to be a big, comprehensive
thing; we just cannot do it one at a time.
I thank you. You have indulged me long enough, and I
appreciate it, Mr. Leader.
Senator Frist. Thank you.
Mr. Swann, could you just comment briefly--and then we have
another panel to continue the whole discussion, so I think we
will move on--but why don't you make a final closing comment,
because I know that is not what you said, but I think it is
important to respond. And in effect, we are all agreeing. This
thing is really big. It is an epidemic. It is increasing. And
having the public and private come together in really
innovative ways, we are going to be able to reverse this.
What I would like to do is have Mr. Swann close and then
bring up the third panel, and then, Senator Wyden, I know you
have been observing, but if you want to make a comment before
the third panel, and then we will go right to them.
Senator Wyden. I do have a question whenever it would be
appropriate, Mr. Chairman.
Senator Frist. OK. Let me just let Mr. Swann comment
quickly, and then I will turn to Senator Wyden.
Mr. Swann. Mr. Chairman, thank you, and Senator Alexander,
it is good to see you again, sir.
I think we are all members of the same choir. We understand
that obesity is a growing epidemic and that we have to turn
this around. It is not going to be an overnight process. It did
not arrive here as an overnight process, and it will not go
away as an overnight process.
We need to attack this in 360 degrees, from all sides, by
approaching children, adults, and senior citizens, educating
them about the value of physical activity, about nutrition,
about making physical activity a priority in all of our lives.
It is not an elective. It is not something we can just take for
granted. If we need to, we will schedule it, but we need to get
physical activity, we need to have proper nutrition in a
balanced way in our lives--and we need to do this in all
aspects. We need to lead by example. We need to reach our
schools to have them teach a better message. We need to reach
out to the private sector, to industry, to community groups, to
create safe walking and biking paths to schools, to create
after-school programs and places where kids can go and feel
safe, where their parents will believe they are safe, where
they can get physical activity. And we need to be able to do it
in the workplace.
We need to be able to make sure that our children
understand and are knowledgeable about how they can live in a
healthy manner so they can make the right decisions.
We need to teach our kids responsibility because all of our
children--all of our children--all of us--made the most
important decisions of our lives when our parents were not
around. When our parents were not around, and we were
approached by a variety of people to do things that we knew
were wrong, we had to have the responsibility to make that
decision. It is paramount that we teach that responsibility to
our children at an early age so that they can make the right
decisions for themselves for a lifetime.
Thank you.
Senator Frist. Thank you, Mr. Swann.
Let me turn to Senator Alexander and then Senator Wyden,
and then I really do want to get to our third panel.
Senator Alexander?
Senator Alexander. I have 60 seconds at this point, and
then I will save my remarks for the third panel.
One, I simply wanted to especially welcome Lynn Swann here.
Listening to him talk about parents and grandparents, I know
where that comes from. He has roots in Blount County, TN where
I am from, and my parents and his grandparents were very good
friends. So I can understand what he just said very, very well,
and I admire his work.
The second thing--and maybe this was discussed earlier, or
maybe someone will discuss it later--one of the major reasons
for physical activity in American public schools is that our
children come from all over the world, and the public schools
were created in the last century. Albert Shanker, the former
head of the American Federation of Teachers, use to say that we
should teach the three R's and teach children what it means to
be an American, and we should hope they would go home and teach
their parents.
Physical activity, recess, and playing together, were
always considered to be good ways to teach children who came
from many different countries--they were not all French, they
were not all Japanese, they were not all from Africa, they were
not all from Scotland; they were people of many different
countries and backgrounds--how to live together by playing
together.
Now, that is a little different than the obesity issue, but
it was an important reason why physical activity was a part of
the early public schools, and with so many new Americans today,
it would be one more arrow in your quiver, one more reason why
physical activity ought to be a regular part of a public school
activity.
Thank you.
Senator Frist. Thank you.
Senator Wyden?
Senator Wyden. I will be under 60 seconds.
Dr. Snider, as we know, some of the hungriest kids are some
of the most obese, and that is almost counterintuitive, because
you say to yourself, well, if they are hungry, they are going
to be thin. But I think what we know is that if they are
hungry, they are likely to be poor, and then they are
particularly going to look at cheap food and whatever is
convenient.
How do we tackle those two problems together, and what are
the latest recommendations with respect to it? Of particular
importance--the majority leader knows this is what drove me to
it--my State is in effect the second hungriest in the country,
and we also have the growing problem of obesity, so in our
State, the two of them are linked.
Dr. Snider. I think you are absolutely right. Poor
families, poor children, tend to make poor food choices because
the least expensive foods contain a lot of sugar, a lot of fat,
and therefore lead to poor nutrition and in many cases,
overweight and obesity.
There have been some programs that have been delivered in a
variety of communities where low-income children have been
brought to the school and of course given a comprehensive
education about nutrition and physical activity and so forth,
but actually provided appropriate nutrition at the school for a
nutritious breakfast, for example, a nutritious lunch.
I think there are ways to begin to address this problem. I
think on a larger macroeconomic scale, though, we are going to
have to figure out from an economic perspective how we can make
more nutritious food more economically attractive and less
nutritious food less economically attractive. It boils down
basically to that, and how to make structural changes to
achieve that is something that I think we all have to work
together to figure out.
Senator Wyden. Thank you, Mr. Chairman.
Senator Frist. Thank you.
I thank both of you. Your articulate way of describing
where we are today and where we need to go is very, very
helpful.
Thank you.
Senator Frist. With that, I would like to welcome the third
panel and ask them to come forward. I will introduce them as
they come forward, and then we will proceed down the line with
their presentations.
Today's third panel will focus on public-private
partnerships that are currently working to reduce obesity in
America's children.
First, we have William Potts-Datema, who serves as director
of Partnerships for Children's Health at the Harvard School of
Public Health in Boston. He is also chair of Action for Healthy
Kids, a nationwide initiative dedicated to improving the health
and educational performance of children through better
nutrition and physical activity in schools.
Ross Brownson is a professor of community health and
epidemiology at Saint Louis University School of Public Health.
Dr. Brownson is a member of the committee on Prevention of
Obesity in Children and Youth, which authored the recent
Institute of Medicine Report, ``Preventing Childhood Obesity:
Health in the Balance.''
Gary DeStefano is our final panelist, and he is president
of USA Operations for the Nike Corporation. Gary is an avid
athlete and supporter of Nike's anti-obesity partnerships,
including the NikeGO program and PE2GO program.
I want to welcome all three of you, and I think we will
proceed in that order, beginning with Mr. Potts-Datema.
STATEMENTS OF WILLIAM POTTS-DATEMA, CHAIRMAN, ACTION FOR
HEALTHY KIDS, AND DIRECTOR OF PARTNERSHIPS FOR CHILDREN'S
HEALTH, HARVARD SCHOOL OF PUBLIC HEALTH, BOSTON MA; ROSS C.
BROWNSON, PROFESSOR OF EPIDEMIOLOGY, SAINT LOUIS UNIVERSITY
SCHOOL OF PUBLIC HEALTH, ST. LOUIS, MO, AND MEMBER, COMMITTEE
ON THE PREVENTION OF OBESITY IN CHILDREN AND YOUTH, INSTITUTE
OF MEDICINE; AND GARY M. DESTEFANO, PRESIDENT, USA OPERATIONS,
NIKE CORPORATION, BEAVERTON, OR
Mr. Potts-Datema. Thank you, Mr. Chairman and members of
the committee. Thank you for the opportunity to testify before
you today.
I am William Potts-Datema. I am director of Partnerships
for Children's Health at the Harvard School of Public Health,
but I am here today in my role as chairman of Action for
Healthy Kids, the only combined national grassroots effort to
address the crisis of childhood overweight in America by
focusing on changes in the school environment in particular.
The landmark 2001 Surgeon General's Report on Overweight
and Obesity detailed the devastating and growing societal
consequences of the epidemic in our country. The report
included a ``Call to Action'' which identified schools as a
critical environment that needed immediate attention.
Schools are in a unique position to help prevent and
decrease childhood overweight. In schools, children spend a
significant portion of their waking hours--at least 1,250 hours
each year. In schools, children learn significant and lasting
lessons about nutrition and physical activity both from the
curriculum and from the examples of their teachers and peers.
Schools provide all children equal access to information
about nutrition and physical activity regardless of their
family's background, socioeconomic status, or prior knowledge
of these issues. The influence of schools cannot be overstated.
In response to the Surgeon General's ``Call to Action'' the
Nation's leading health, nutrition, education and physical
activity organizations convened to determine steps that could
be taken within the school environment to address this crisis.
These leaders, representing more than 35 national organizations
and government agencies, agreed that meaningful change would
require a public-private partnership of the broadest scope, and
they adopted the goals outlined in the ``Call to Action'' as
the focal point of their work.
The initiative began with the Healthy Schools Summit held
here in Washington, D.C. 2 years ago on October 7, 2002.
Chaired by former Surgeon General David Satcher with Mrs. Laura
Bush serving as honorary chair and with the participation of a
number of other esteemed individuals, including the
distinguished majority leader, the summit brought together a
standing-room-only crowd of more than 500 dedicated individuals
from every State in our Nation.
These participants were clear and united in their call for
a multidisciplinary public-private initiative with support and
guidance at the national level but with the real action taking
place at the grassroots level within our schools.
So Action for Healthy Kids was born. In less than 2 years'
time, we have created an infrastructure that combines national
support with guidance and expertise from more than 40 national
organizations and government agencies. The 51 Action for Health
Kids State Teams have become centers for creative action within
their States, building momentum toward positive changes within
the school environment.
Each Action for Health Kids State Team is a freestanding,
diverse collaboration of volunteers from the private, public,
and nonprofit sectors. All State Teams have chosen priorities
developed from the ``Call to Action'' based on their own
evaluations of State needs and factoring the current status of
local school environments. From there, State Teams have
developed goals and action plans to address their specific
priorities.
Using assistance from the national office, these teams
regularly share timely information, success stories, and best
practices across the network. As we speak, State Teams are
working in every State to improve children's eating habits,
increase their physical activity, and educate them about the
supportive role of sound nutrition and physical activity in
academic achievement.
I might just mention a couple of State examples. For
example, in Tennessee, the Action for Health Kids State Team is
a coalition that includes members from higher education,
government, health professionals, educators, and industry
leaders. Middle Tennessee State University donates meeting
space, office supplies, and students to help the team
accomplish its goals. The team is working to increase healthy
vending practices throughout all schools. And recently, the
Tennessee Department of Agriculture awarded Agricultural
Development Fund Grant to the team to administer a milk vending
machine grant program in Tennessee public schools.
We have other State examples, and I will not go into those
right now, but they are included within my testimony.
I might just mention about Massachusetts, since I work as
well on the Massachusetts State Team, that we have worked in
concert with the Massachusetts Department of Education and
School Food Service Association to develop and disseminate
nutrition guidelines for a la carte foods and beverages to all
1,893 schools in Massachusetts, and that has the potential to
positively impact over 1 million students.
There are of course many more examples of how Action for
Healthy Kids partnerships are taking action to help improve
nutrition and physical activity, and we encourage you to visit
our website at www.ActionForHealthyKids.org. We also passed
around a copy of the report of Action for Healthy Kids.
Nationally, we have in-kind support from more than 40
organizations and government agencies. We receive funding from
diverse sources including the National Football League, the
National Dairy Council, and the Robert Wood Johnson Foundation,
among others, and we estimate that the initiative receives
approximately $1.5 million annually in the form of in-kind
services and contributions from our more than 4,000 volunteers.
In closing, I speak for myself, my board of directors, and
for the 40-plus partner steering committee organizations, and
for the 51 State Teams in applauding this committee's attention
to this important and timely issue.
We place the childhood overweight epidemic at the top of
our Nation's health care agenda, and beyond that, we believe it
is clear that healthy children perform better in school. We are
confident that, as Dr. David Satcher said at the Healthy
Schools Summit, ``There is no limit to what we can do if we
work together.''
We look forward to working closely with you and others to
continue to develop and nurture alliances and partnerships that
will make a real difference for the health of our Nation's
youth.
Thank you.
Senator Frist. Thank you very much, Mr. Potts-Datema.
[The prepared statement of Mr. Potts-Datema follows:]
Prepared Statement of William Potts-Datema
Mr. Chairman and Members of the Committee, Good morning. I am
William Potts-Datema, director of Partnerships for Children's Health at
the Harvard School of Public Health. I am here today in my role as
chairman of Action for Healthy Kids, the only combined national-
grassroots effort to address the crisis of childhood overweight in
America by focusing on changes in the school environment.
The landmark 2001 Surgeon General's report on overweight and
obesity detailed the devastating and growing societal consequences of
the epidemic in our country. The report included a ``Call to Action''
which identified schools as a critical environment that needed
immediate attention.
Schools are in a unique position to help prevent and decrease
childhood overweight. In schools, children spend a significant portion
of their waking hours, at least 1,250 hours each year. In schools,
children learn significant and lasting lessons about nutrition and
physical activity, both from the curriculum and from the examples of
their teachers and peers. Schools provide all children equal access to
information about nutrition and physical activity--regardless of their
family's background, socio-economic status or prior knowledge of these
issues. The influence of schools cannot be overstated.
In response to the Surgeon General's ``Call to Action,'' the
Nation's leading health, nutrition, education and physical activity
organizations convened to determine steps that could be taken within
the school environment to address this crisis. These leaders,
representing more than 35 national organizations and government
agencies, agreed that meaningful change would require a public-private
partnership of the broadest scope, and they adopted the goals outlined
in the ``Call to Action'' as the focal point of their work. The
initiative began with the Healthy Schools Summit, held here in
Washington, D.C. 2 years ago on October 7, 2002. Chaired by Former
Surgeon General David Satcher with Mrs. Laura Bush serving as Honorary
Chair, and with the participation of a number of other esteemed
individuals--including the distinguished majority leader--the Summit
brought together a standing-room-only crowd of more than 500 dedicated
individuals from every State in our union. These participants were
clear and united in their call for a multi-disciplinary public-private
initiative with support and guidance at the national level, but with
the ``real'' action taking place at the grassroots level within our
schools.
And so, Action for Healthy Kids was born. In less than 2 years'
time, we have created an infrastructure that combines national support
with guidance and expertise from more than 40 national organizations
and government agencies. The 51 AFHK State Teams have become centers
for creative action within their States, building momentum towards
positive changes within the school environment. Each AFHK State Team is
a free-standing, diverse collaboration of volunteers from the private,
public and non-profit sectors. All State Teams have chosen priorities
developed from the ``Call to Action'' based on their evaluations of
State needs and factoring the current status of local school
environments. From there, State Teams have developed goals and action
plans to address their specific priorities. Using systems coordinated
through our national office, these teams regularly share timely
information, success stories and best practices across the network. As
we speak, State Teams are working in every State to improve children's
eating habits, increase their physical activity, and educate them about
the supportive role of sound nutrition and physical activity in
academic achievement.
For example, Tennessee AFHK State Team is a coalition that includes
members from higher education, government, health professionals,
educators and industry leaders. Middle Tennessee State University
donates meeting space, office supplies, and students to help the team
accomplish its goals. The team is working to increase healthy vending
practices throughout in all schools. Recently, the Tennessee Department
of Agriculture awarded an Agricultural Development Fund Grant to the
team to administer a milk vending machine grant program in Tennessee
public schools.
The NH AFHK team has been working with NH Department of Education
to develop ``best practices'' recommendations for physical education
and physical activity, which will then be disseminated to all schools.
While the MA AFHK team collaborated with the MA Department of Education
and MA School Food Service Association to develop and disseminate
nutrition guidelines for a la carte foods and beverages to all 1,893 MA
school districts, having the potential to positively impact nearly
1,000,000 students.
Another example comes from Texas, where AFHK has provided training
for 22 regional health specialists that are working to establish
Coordinated School Health councils throughout the State in response to
a legislative mandate. These specialists are helping to assess school
districts' needs, coordinate professional development, locate available
resources and promote collaboration between schools, health agencies,
and the community. Improving nutrition and physical activity are core
activities for the Coordinated School Health councils.
There are, of course, many more examples of how State AFHK
partnerships are taking action to help improve nutrition and physical
activity and we encourage you to visit our web site at
www.ActionForHealthyKids.org. Nationally, we have in-kind support from
more than 40 organizations and government agencies. We receive funding
from diverse sources, including the National Football League, the
National Dairy Council and the Robert Wood Johnson Foundation, and we
estimate that the initiative receives approximately $1.5 million
annually in the form of in-kind services and contributions from our
4,000-plus volunteers.
I speak for myself, for my Board of Directors, for the 40-plus
Partner Steering Committee organizations, and for the 51 State teams in
applauding this Committee's attention to this important and timely
issue. We place the childhood overweight epidemic at the top of our
Nation's healthcare agenda, and, beyond that, we believe it is clear
that healthy children perform better in school. We are confident that,
as Dr. David Satcher said at the Healthy Schools Summit, ``There is no
limit to what we can do if we work together.'' We look forward to
working closely with you and others to continue to develop and nurture
alliances and partnerships that make a real difference in the health of
our Nation's youth.
Thank you.
Senator Frist. Mr. Brownson, thank you for being with us.
Mr. Brownson. Good morning, Mr. Chairman and members of the
committee.
My name is Ross Brownson. I am a professor of epidemiology
and department chair at Saint Louis University School of Public
Health. I also recently served as a member of the Committee on
the Prevention of Obesity in Children and Youth of the
Institute of Medicine.
I am here today to talk about our recent IOM report,
``Preventing Childhood Obesity: Health in the Balance,'' which
was undertaken at the request of Congress and was released last
Thursday, September 30. Our report provides the first
comprehensive, evidence-based action plan for tackling the
epidemic of childhood obesity on multiple fronts.
We call for immediate action given the alarming rate at
which the incidence of childhood obesity is growing in America.
You have already heard those rates, and we know that these
increases will hold a significant toll for our children's
health in the future.
Our Nation has spent many billions of dollars to make
incredible health advances related to genetics and other
biomedical discoveries, yet these advances could be offset by
the burden of illness and premature death caused by too many
young people eating too much and moving too little over their
lifetimes.
Reducing rates of childhood obesity requires that children
achieve and maintain a healthy energy balance--that is, the
balance between amount of calories consumed and the amount
expended through physical activity.
The Federal Government must provide the leadership that is
needed to make obesity prevention a national public health
priority, and therefore, our report calls for the establishment
of a high-level Federal task force to ensure coordinated
budgets, policies, and programs.
The report also recommends pilot programs to explore
changes in Federal food assistance programs that could promote
healthy eating. We also urge an increase in resources devoted
to obesity prevention programs, surveillance and research, such
as those overseen now by the CDC and the NIH.
Naturally, we call on parents and families to encourage
their children to engage in regular physical activity, to
provide them with healthy foods, and to serve as good role
models. We recommend that parents limit television and other
recreational screen time to no more than 2 hours per day.
We call on schools, from preschool through high school, to
implement nutritional standards set at the national level for
all foods and beverages served on school grounds, including
those dispensed by vending machines. Schools also should expand
opportunities for all students to engage in at least 30 minutes
of moderate to vigorous physical activity; that contributes to
the total of 60 minutes per day mentioned earlier.
The report also calls on the food, beverage and
entertainment industries to develop innovations related to
healthier food and beverage product and packaging. We need
these industries to provide clear and consistent media messages
promoting energy balance.
Further, the report calls for the relevant industries to
voluntarily develop and implement guidelines for advertising
and marketing directed at children. Congress should give the
Federal Trade Commission the authority to monitor compliance
with these guidelines and to establish external review boards
to prohibit ads that fail to comply.
Community organizations and local and State governments
should expand programs and need to engage youth-centered
organizations, faith-based groups, and many other community
partners. Local action must focus on improving the so-called
built environment--bike paths, sidewalks, and playgrounds--
through capital investment and local zoning. For example, we
must find ways for getting our children walking and biking to
school again.
Health care professionals also have a vital role in
preventing childhood obesity. They have the access and
influence to discuss a child's weight status with parents, and
can make credible recommendations on dietary intake and
physical activity. We need to better train health professionals
to routinely assess body mass and to counsel patients and
families on weight. Specific attention must be given to
children who are at especially high risk for becoming obese,
especially ethnic minority populations and families of lower
socioeconomic status.
As our Nation focuses on obesity and begins to address the
societal influences that contribute to excess weight, poor food
choices, and physical inactivity, many different groups,
industries, and organizations will need to make difficult
choices. Our report is calling for fundamental changes in our
society in how we view childhood obesity. No single sector
acting alone can solve this problem.
Because the epidemic has taken years, literally decades, to
develop, it will require a sustained commitment of effort and
resources for many years--possibly decades--to effectively
address the problem. Several recent bills introduced by members
of this committee take a comprehensive approach to this
problem. This is a collective responsibility, and we as a
Nation need to provide a healthier environment in which our
children can grow up.
Thank you for the opportunity to address this important
topic, and I will be glad to answer questions at the
appropriate time.
Thank you.
Senator Frist. Thank you.
[The prepared statement of Mr. Brownson follows:]
Prepared Statement of Ross C. Brownson, Ph.D.
Good morning, Mr. Chairman and Members of the Committee. My name is
Ross Brownson. I am a professor of epidemiology and department chair at
Saint Louis University School of Public Health. I also served as a
member of the Committee on the Prevention of Obesity in Children and
Youth of the Institute of Medicine.
I am here to talk about our recent IOM report, Preventing Childhood
Obesity: Health in the Balance, which was undertaken at the request of
Congress and was released last Thursday, September 30. Our report
provides the first comprehensive, evidence-based action plan for
tackling the epidemic of childhood obesity on multiple fronts.
We call for immediate action, given the alarming rate at which the
incidence of childhood obesity is growing in America. Over the past 3
decades, the obesity rate has more than tripled for children ages 6 to
11 years. Obesity carries significant ramifications for children's
physical and emotional health, in both the short and long terms,
particularly the increased risk of developing diabetes and other
chronic conditions. Our Nation has spent many billions of dollars to
make incredible health advances related to genetics and other
biomedical discoveries; yet these advances could be offset by the
burden of illness and premature death caused by too many young people
eating too much and moving too little over their lifetimes.
Reducing rates of childhood obesity requires that children achieve
and maintain a healthy energy balance--that is, the balance between
amount of calories consumed and the amount expended through physical
activity.
The Federal Government must provide the leadership that is needed
to make obesity prevention a national public health priority and
therefore, the report calls for the establishment of a high level
Federal task force to ensure coordinated budgets, policies, and
programs. The report recommends pilot programs to explore changes in
Federal food assistance programs that could promote healthy eating. We
also urge an increase in resources devoted to obesity prevention
programs, surveillance, and research, such as those overseen by the CDC
and the NIH.
Naturally, we call on parents and families to encourage their
children to engage in regular physical activity, to provide them with
healthy foods, and to serve as good role models. We recommend that
parents limit television and other recreational screen time to no more
than 2 hours a day.
We call on schools, from preschool through high school, to
implement nutritional standards set at the national level for all foods
and beverages served on school grounds, including those dispensed by
vending machines. Schools also should expand opportunities for all
students to engage in at least 30 minutes of moderate to vigorous
physical activity each day.
The report also calls on the food, beverage, and entertainment
industries to develop innovations related to healthier food and
beverage product and packaging and to provide clear and consistent
media messages promoting energy balance. Further, the report calls for
the relevant industries to voluntarily develop and implement guidelines
for advertising and marketing directed at children. Congress should
give the Federal Trade Commission the authority to monitor compliance
with the guidelines and establish external review boards to prohibit
ads that fail to comply.
Community organizations and local and State governments should
expand programs and need to engage youth-centered organizations, faith-
based groups, and many other community partners. Local action should
focus on improving the so-called ``built environment''--bike paths,
sidewalks, and playgrounds--through capital investment and local
zoning. For example, we must find ways for getting our children walking
and biking to school again.
Health care professionals have a vital role in preventing childhood
obesity. They have the access and influence to discuss a child's weight
status with parents, and can make credible recommendations on dietary
intake and physical activity. We need to better train health
professionals--to routinely assess body mass and to counsel patients
and families on weight.
Specific attention must be given to children who are at especially
high risk for becoming obese, especially ethnic minority populations
and families of lower socioeconomic status.
As our Nation focuses on obesity and begins to address the societal
influences that contribute to excess weight, poor food choices, and
physical inactivity, many different groups, industries, and
organizations will need to make difficult choices. Our report is
calling for fundamental changes in our society on how we view childhood
obesity--no single sector acting alone can solve it. Because the
epidemic has taken years to develop, it will require a sustained
commitment of effort and resources for many years--possibly decades--to
effectively address this problem. Several recent bills, introduced by
Members of this Committee, take a comprehensive approach to this
problem. This is a collective responsibility and we, as a Nation, need
to provide a healthier environment in which our children can grow up.
Thank you for the opportunity to speak with you on this important
topic. I would be glad to answer your questions.
Senator Frist. Mr. DeStefano?
Mr. DeStefano. Good morning, Mr. Chairman, Senator
Alexander. It is a pleasure to be here. Thank you for inviting
us this morning. It is a pleasure to give testimony in front of
the committee, and we thank your committee for the leadership
on this issue. We also want to thank the Senate majority leader
for his leadership in sponsoring this bill and for the
sponsorship of our great Senator, Senator Wyden, from the State
of Oregon.
It is a pleasure to be here with you this morning. We would
ask that our testimony actually be recorded into the record----
Senator Frist. It will be.
Mr. DeStefano [continuing]. And I have been counseled to
just dialogue with you about why Nike is here and what we are
doing about this issue.
Why Nike is here is probably because of our position as the
leader within the sports and fitness industry, and probably
because I hold the leadership position in that company. But
that is not why we choose to work on this issue or why we
choose to appear this morning.
We choose to work on the issue and we choose to appear this
morning because of the passion that we share about this issue,
which is really heartfelt, as you shared this morning.
The passion is also well-rooted in the company. It is a
mission similar to the committee's objectives here. The mission
of Nike is to provide innovation and inspiration to every
athlete in the world, and we asterisk that comment about the
athlete to say if you have a body, you are an athlete. It is a
very inclusive statement, very inspiring and has helped us
reach a number of children.
What is Nike doing about this issue? We have created a
signature program that was referred to by the Senator called
NikeGO. It has a very simple strategy--to get kids active and
give them the means to do it. It is a three-pronged strategy
around giving kids content and programming. We have a unique
way to connect with kids to inspire them to continue to be
physically active.
We want to create facilities for kids that are safe--we
mentioned the safe playgrounds for kids earlier--and that they
have access to; and last, advocacy. We have been told by many
of our constituencies that Nike is putting its money where its
mouth is, but one of the most important things Nike could do
for those organizations is to actually put our mouth where our
money has been. So we believe that advocacy is very important.
On the content side, there are two real programs that Nike
has featured in our testimony, one about Native Americans.
Sixty tribal leaders visited the Nike campus this past year and
asked us for help in creating programming for their tribal
members. They had tremendous funding from the U.S. Government
but needed a way to inspire their people to participate.
They told us if you could increase activity levels 10 to 20
percent, they could reduce their Type 2 diabetes by 40 to 50
percent. We knew that was something that we could do. So we
have taken up with them, and we have a goal established for
ourselves to have 1 million Native Americans active by the year
2006, and our programs are now working with 80 tribal leaders
across the Nation.
Second, with PE2GO, which was mentioned in the earlier
testimony, we are reaching out to schools. We believe we have a
captive audience in the schools. We are going to where the
students are. We believe we should provide physical activity to
students during the day at school.
Nike has created a content-based curriculum through San
Diego State University to provide content curriculum that could
be led by any person in that organization at the school level.
It could be led by you, it could be led by me, it could be led
by any teacher, not necessarily a physical education
specialist. We are very proud of that program, and we continue
to work to roll that out; it is in six cities as we speak
today.
On facilities--safe and accessible facilities for children
to play--Nike has a very innovative program where we have
donated in 30 States across the Nation over 163 facilities,
safe facilities, and actually, world-class facilities for
children to participate in. That is very inspirational. I do
not know when was the first time you ever walked into a major
professional ball park, but the surface is the same as that
found in the Seattle Seahawks stadium, or in what was found at
the Sydney Olympic Games, billed as ``the greenest games.''
This also serves a twofold purpose. We recycle over 16
million shoes that would have gone into landfills to help
create a safe and soft playing surface for these children. It
has really become a tremendous program. I actually worked with
some of the congressional staffers last year and the National
Recycling Coalition on that program. So it is a very innovative
program.
On advocacy, in 2003, we co-funded ``Shaping America's
Youth'' with the Surgeon General, Richard Carmona, in the
Department of Health and Human Services. As mentioned earlier,
the Surgeon General's office has really been a tremendous
partner for us. The goal is to develop public and private
partnerships and promote healthy lifestyles. So far, this
organization has identified over 1,100 disparate organizations,
all working on this issue, as Senator Harkin testified earlier.
Our goal is to create a series of town halls across the
Nation and to create a public forum, a public dialogue, and
most important, a national action plan on this issue.
In closing, I want to thank members of the committee,
specifically the Senate majority leader, for your leadership
and this committee's leadership. I want to again thank our
Senator Wyden for his leadership on this and your invitation
today to be with you.
The pessimists would say we are tackling an enormous issue
that cannot be solved. The optimists in all of us that I have
heard in this room this morning would say that this is one of
the few diseases for which we know the cause and we know the
cure. We are happy to partner with you to provide both of those
things, and we leave you here with our commitment to continue
to provide innovation and inspiration to every athlete in the
world.
Thank you.
[The prepared statement of Mr. DeStefano follows:]
Prepared Statement of Gary DeStefano
Majority Leader Frist, Chairman Gregg, Senator Kennedy, Senator
Wyden and other distinguished Members of the Committee. Thank you for
the opportunity to speak to you today regarding Nike's strong support
of The Childhood Obesity Reduction Act and the important role public-
private partnerships play in tackling this issue. Like all of you, we
at Nike are very concerned about the current epidemic of youth
inactivity among children in the United States. It is a troubling fact
that as a result of inactivity and diet, today parents have a longer
life expectancy than their children.
As president of U.S. operations for the world's leading sports and
fitness company and as a former physical education teacher, I am
passionate about finding a solution to this national health crisis and
proud to bring the commitment of Nike to work with you and others on
this issue. Unhealthy weight results from two major sources: lack of
physical fitness and poor nutrition. Nike's programs and efforts focus
exclusively on the issue of physical fitness, and we trust that other
companies will address nutritional challenges.
THE PROBLEM
Today, I want to talk about the role physical inactivity plays in
fueling this national epidemic that threatens our youth. Health
professionals agree that kids should take part in a minimum of 30
minutes of moderate to vigorous physical activity daily.
Only one in four U.S. public school students attends regular P.E.
classes. A 2000 study conducted by the CDC found that less than one in
10 elementary schools and roughly one in 20 junior and senior high
schools provide daily P.E. all year in all grades.
We know the benefits of regular physical activity. Children who are
physically active:
reduce their risk of cancer and their vulnerability to
depression, anxiety and low self-esteem;
are more likely to graduate from high school;
are less likely to use drugs;
are less likely to have an unwanted pregnancy;
are less likely to join gangs;
are less likely to develop an eating disorder.
The benefits of regular physical activity also extend into the
classroom. A 2002 California Department of Education study found
significant correlations between physical fitness scores and reading
and math scores on standardized tests for middle school children. Those
children who scored highest on the physical fitness tests also scored
highest on the standardized tests. And a 1999 study published in
Research Quarterly showed that students who spent up to 200 percent
more time in P.E. class (compared to students who spent that same time
in the classroom) did as well or better on standardized test scores.
NIKE RESPONSE TO THE CHILDHOOD OBESITY REDUCTION ACT
Nike is fully supportive of S. 2551, and we believe this important
legislation is a critical component in tackling this issue. On behalf
of Nike's 12,000 U.S. employees--6,275 of whom are in Oregon and 1,436
in Tennessee--we applaud Majority Leader Frist's and Senator Wyden's
leadership on this matter.
The severity of this epidemic and its impact on our children's
future requires new thinking and new approaches. The Childhood Obesity
Reduction Act presents a unique opportunity for schools and communities
to develop and implement real solutions to promote increased physical
activity, reduce and prevent childhood unhealthy weight, and improve
nutritional choices in schools.
Through the proposed Congressional Council on Childhood Obesity and
the creation of a National Foundation for the Prevention and Reduction
of Childhood Obesity, elementary and middle schools across the country
will have the opportunity to partner with public and private entities
to create successful strategies to tackle this issue at the local
level.
Creating a Council and then a Foundation to support creative school
programs is important for many reasons. First, it encourages creativity
and rewards best practices for model programs. Second, it provides a
convenient mechanism to garner additional private support for this
growing crisis. However, as good as this legislation is, it alone won't
solve this rising problem. A profound and long-term impact requires
broader and other creative initiatives that must be well coordinated.
We believe the Foundation created by this legislation could help play a
key coordinating role.
NIKE'S APPROACH
In many ways, Nike's own thinking and approach toward addressing
this national epidemic are very similar. Nike has a long history of
supporting sport and physical activity programs. But 3 years ago, as we
began to get a better understanding of the scope and scale of this
health problem, we raised the stakes. We started by talking to experts
in the field about the root causes and cures, and the role Nike could
play in helping to address the issue. We evaluated the most effective
programs that address youth inactivity and unhealthy weight. We looked
for innovative and creative approaches that address youth physical
inactivity from all directions and at all stages of childhood.
As a sports and fitness company, we know firsthand the value that
daily physical activity can offer--both to kids and adults. And we
recognize that through the power of our brand, we are in an excellent
position to help tackle this issue. But we realize that as passionate
as we are about getting kids active, we simply can't do this alone.
That is why we created a long-term, multi-stakeholder initiative to
address youth inactivity called NikeGO. We have partnered with
organizations whose expertise brings greater impact to the programs we
build for inactive kids and the parents, teachers and coaches who
influence their behavior. And we are using this same partnership
strategy with the advocacy efforts we launch regionally and nationally
to drive policy-level changes on this issue.
Today I would like to talk to you about four long-term NikeGO
programs.
PE2GO
In the fall of 2003, NikeGO teamed up with an organization based at
San Diego State University called SPARK (Sports, Play and Active
Recreation for Kids) to create a program called PE2GO. SPARK is a
research-based organization dedicated to creating, implementing and
evaluating physical activity programs that promote lifelong wellness in
children and youth.
PE2GO is a national, standards-based program designed by Nike and
SPARK to help increase the quality and quantity of physical education
in schools where P.E. classes have been drastically reduced or
eliminated. Nike and SPARK deliver custom curriculum, training and
equipment to classroom teachers, not P.E. teachers, to enable them to
teach P.E. to fourth and fifth grade students in schools where P.E.
classes have been drastically reduced or eliminated.
In the fall of 2003, PE2GO launched in six U.S. cities--Akron,
Ohio; Chicago; Los Angeles; Memphis; New York; and Portland--reaching
over 6,400 fourth and fifth graders in 43 elementary schools.
Here is an astonishing fact: Many of us grew up with the ``old
P.E.,'' which is still being taught to many of our kids today. PE2GO is
designed to fix a significant problem plaguing those traditional P.E.
classes, where kids spend only 3 and a half minutes of a half-hour
class in active movement.
PE2GO is part of the ``New P.E.,'' a movement where students no
longer stand on the sidelines or in line waiting for a turn to play.
All kids get the same opportunities to participate, develop skills and
feel successful, and all kids are moving for the full 30 minutes.
Classroom teachers are involved because in many districts P.E.
specialists see students only once a week--insufficient frequency and
duration to achieve health benefits.
PE2GO provides schools with a self-contained, standards-based P.E.
program that gives classroom teachers the tools to help get their kids
moving 3 times a week for a minimum of 30 minutes each time.
Based on an evaluation by the CDC, the first year of PE2GO
demonstrated more than just physical benefits:
nine out of ten kids are more active, and enjoy it;
three out of four kids learned physical activities that
can be enjoyed for a lifetime;
three out of four kids learned to cooperate with others
and improve social skills;
classroom teaching skills improved;
majority of kids' sports and movement skills, as well as
fitness levels, increased.
Even more exciting, we see both teachers and kids develop a real
commitment to the program. One of my favorite activities in this year's
lesson plans was a game called ``Heart Attack.'' This innovative tag
game teaches children about healthy lifestyle choices and the important
role physical activity plays in combating heart disease. The game with
the alarming name allows kids to come to each other's aid and rescue
their peers by exercising with them after they've been tagged and given
a risk factor by someone who's ``it.''
In June of this year, we had the opportunity to demonstrate our
interpretation of the ``New P.E.'' to Members of the Administration and
Congress. Nike and SPARK were among the more than 50 organizations to
participate in the HealthierUS Fitness Festival on the National Mall.
The President's Council on Physical Fitness and Sports joined with
Secretary of Health and Human Services Tommy G. Thompson; Secretary of
Education Rod Paige; U.S. Surgeon General Dr. Richard Carmona; and
Congressmen Zach Wamp and Mark Udall, Co-Chairs of the Congressional
Fitness Caucus, to organize and showcase activities and resources
available to get Americans moving for health.
NATIVE AMERICAN DIABETES PREVENTION PROGRAM AND NIKEGO IN INDIAN
COUNTRY
Nike's Native American Diabetes Program is currently working
closely with the diabetes program coordinators of some 80 tribal
agencies across the United States. Nike provides product for their
fitness promotion programs and partners with these tribes to offer
mentoring and recreational events for the tribal population.
Nike will also partner with the National Indian Health Board and
Indian Health Services to launch a national fitness program called
``Just move it'' targeted at tribal health programs, tribal schools and
recreational programs with the goal of getting 1 million Native
Americans active by 2006.
Nike and IHS signed a Memorandum of Understanding (MOU) to
collaborate on the promotion of healthy lifestyles and healthy choices
for all American Indian and Alaska Natives. The MOU is a voluntary
collaboration between business and government that aims to increase
dramatically the amount of health information available to American
Indian and Alaska Native communities. The goal of the MOU is to help
those communities gain a better understanding of the importance of
exercise at any age, particularly for those individuals with diabetes.
REUSE-A-SHOE/NIKEGO PLACES
Creating places for youth to play is another component of NikeGO.
For more than 11 years, the Nike Reuse-A-Shoe program has recycled and
reused non-metal containing post-consumer and defective athletic shoes
to turn them into NikeGO Places--sports surfaces such as football,
baseball and soccer fields; basketball and tennis courts; tracks; and
playgrounds.
Since the program began, we've collected more than 16 million pairs
of shoes, and have helped donate more than 170 NikeGO Places around the
world. In 2002, to celebrate our 30th anniversary as an Oregon-based
company, we made our largest one-time surface donation with a $2
million gift to Portland Parks Foundation to resurface 90 existing
outdoor basketball courts in 35 Portland parks. Our partnership with
Portland Parks & Recreation continues with after-school and summer
programs.
Last year, Nike partnered with Congress and the National Recycling
Coalition to collect shoes from congressional staffers to be used to
build play surfaces. Senator Wyden has been a long-time advocate and
supporter of the Reuse-A-Shoe program and recently sponsored and passed
legislation to keep this program alive.
Other partnerships include the U.S. Soccer Foundation, where
together we have awarded eight $100,000 grants to be used toward world-
class FieldTurf soccer fields to eight communities including Beaverton,
Ore.; Hampton, N.H.; New York, N.Y.; Richmond, Va.; and St. Louis, Mo.
This recent award is part of a 5 year, $5 million partnership between
NikeGO and the U.S. Soccer Foundation to promote the sport of soccer
across the United States by awarding 50 communities grants to be used
toward the installation of FieldTurf soccer fields.
NIKEGO ADVOCACY
In addition to in-school and after-school programs and creating
safe places for kids to play, we are also lending our support to
advocate for public policies that will drive real changes on this
issue.
In November 2003, we co-founded Shaping America's Youth with the
U.S. Surgeon General, the American Academy of Pediatrics, McNeil
Pharmaceuticals, The Campbell Soup Company and others to develop a
national, cross-sector initiative devoted to promoting physical
activity and healthy lifestyles. A true private-public partnership, we
launched the results of a 3 month national survey last week that
identified nearly 1,100 childhood physical activity, nutrition and
weight management programs nationwide. Some of the most revealing data
points include:
Of those surveyed, upwards of an estimated $7 billion is
being invested in operational programs in 2004;
40 percent of surveyed programs are only funded for a
single year;
Only 53 percent of programs had plans to measure outcomes
and thereby determine effectiveness;
Only 4 percent of all programs have reported any outcomes;
91 percent of those surveyed expressed a strong need for a
national dialogue, creations of partnerships and a need for national
standards.
While the survey results highlight a significant commitment and
level of investment, we have yet to make a real impact in reversing
this trend. The need for a coordinated plan of action couldn't be more
obvious. In March 2005, Shaping America's Youth will hold its first
Town Hall Meeting in Memphis, Tenn., as part of a process to create
shared language and recommendations that will lead to a national action
plan. Majority Leader Frist, we welcome your participation in this
event.
Nike also believes that one of the ways we can help reverse this
trend of youth inactivity is to call for companies, organizations and
government to work together to help bring daily P.E., taught by P.E.
specialists, back to schools. We are using our knowledge and resources
to talk to policymakers around the country about the importance of
daily physical educations classes.
As you indicate in your legislation, children spend a considerable
amount of time in school, and schools are a powerful motivator for
helping kids adopt healthy lifestyles. Several studies demonstrate that
school-based P.E. programs are one of the most effective ways to
facilitate activity in our youth.
In fact, a study released last month by the NIHCM Foundation found
that expanding existing P.E. instruction nationwide to at least 5 hours
per week for kindergarteners could reduce overweight levels in girls by
43 percent and in children at risk for overweight by 60 percent. Those
are stunning outcomes, at very little cost.
By inspiring, enabling, and encouraging kids to be physically
active, Nike has an opportunity to shape kids lives now, and help them
form positive habits and attitudes that last a lifetime. This
opportunity can be realized in traditional ways--through products that
perform well, images that show movement and athleticism--and through
innovative community affairs programs that provide the resources,
facilities, gear and coaching that kids need.
By reaching out to partners in the corporate, nonprofit and
government arenas, we can help kids make changes and choices that
remove obstacles between young people and physical activity. If we do,
we can all help kids lead physically healthier lives and leave a legacy
of strong mental, social and physical health.
We thank you for your leadership on this issue and look forward to
working with you.
Senator Frist. Thank you. I thank all three of you.
In many ways, this panel really captures the importance of
the public-private partnerships, innovative programs, creative
programs, combining scholarship, evaluation on what we do know
and then to be able to shed more light on that and spread it
around the country.
I think many of the statements that were made just prior to
this panel and during this panel to me do capture the
excitement in many ways of being able to participate together,
using government in a careful way, and the great dynamism and
innovation that we know comes from the private sector together
to address a problem that is real, whether it is the
incremental economic impact on our medical system or the
individual, whether or not one can live a fulfilling life. It
is a mosaic, and it is going to take a corresponding mosaic of
approaches, I think, to address it, and this panel really
captured that.
I need to slip back to the floor of the Senate but wanted
to stay to listen to your testimony. Your written testimony,
which goes into a lot more detail, has been and will be shared
with all of our colleagues, and from that and with the
commitment of the panel of Senators that you have heard today
and the presentation by Senator Wyden, I hope that we reflect
to you our commitment to the work that you do every day, all
day long. To me, it is very, very exciting.
So I wanted to thank you, and I am going to turn to Senator
Alexander and ask him to complete an appropriate round of
questioning and then terminate the hearing.
Thank you all very much.
Senator Alexander [presiding]. Thank you, Senator Frist,
and thank you to the witnesses.
I want to thank Senators Frist and Wyden for putting
attention to this issue. The Senate operates in an unusual way.
It operates by unanimous consent. So for the leader of the
Senate to have been here for this much time is really pretty
remarkable and shows his devotion to the subject. So I welcome
his participation and Senator Wyden's as well.
I have a question that I will ask the three of you, and I
will then ask Senator Wyden if he has any comment or question,
and then we will conclude the hearing.
As I have listened and read your testimony, I have been
thinking of three types of examples of dealing with this
epidemic, as it has been called, and let me mention all three
of them and see if you have any comment. Maybe one of these
activities are already happening.
No. 1, Mr. DeStefano, when I think of this issue, I think
back to the eighties and illegal drugs and the American
attitude toward drugs then. The problem is that as we went into
the eighties, there was a body of opinion in America that said
drugs were okay, and that had to be changed. One of the most
effective measures that was taken to change that was media
advertising, and one of the leaders of that effort, whose name
I have unfortunately forgotten, was the chairman of Johnson and
Johnson at that time. They put together a very skilled and
sophisticated set of advertising.
So that is point one, and I think of you particularly
because you are so successful in your company with advertising
and changing the minds of individuals.
The second thing I want to ask about, really, because I
have not kept up with it, is whether there are any national
standards for physical fitness in elementary and secondary
education today. When I was Secretary of Education, we were
busy trying to implement the Education Summit that the first
President Bush and Governors had in 1989, and that focused on
math, science, English, history and geography. And I very well
remember Arnold Schwarzenegger coming around to the Department
of Education at the time, because he was visiting all the
States, to encourage the addition of national standards in
physical fitness to go along with math, science, English,
history, and geography. These were not standards that
Washington imposed on anyone. These were standards that States
and local schools might adopt if they chose to, but they were
very, very important. For example, in terms of mathematics, the
National Council of Mathematics Teachers has basically
revolutionized the mathematics curriculum in America in the
last 20 years by standards that they did not impose on anyone
but they just adopted themselves.
So I wonder what is the status of standards?
And the third question I want to ask, for any of you to
comment on, is I had a visit the other day with Governor
Huckabee of Arkansas, who has lost the weight of my wife
himself. He has lost 105 pounds in the last year or 18 months.
He will be chairman of the National Governors' Association in a
year. He is obviously on a mission on this subject and could be
a very important ally in the cause.
While we in the Federal Government talk a lot about
schools, we provide about 7 percent of the funding for schools,
so all the action with schools really is State and local.
He suggested--and this is the third point I wanted to ask
you about--that in Arkansas, they were considering lower
insurance rates for State employees who met their weight
levels. I wondered if that is widespread or if that is a good
idea.
So my questions are, one, what about attitude-changing
national media with the brilliance of Nike's advertising;
number two, what is the status of national standards for
physical fitness, do we have them, and have they worked; and
three, what about the idea of government setting an example by
offering--and we could do this in the Federal Government--
lower-cost health insurance to employees who meet certain
weight standards?
Mr. Potts-Datema. I can field the standards question, but
does anyone want to take the advertising question first?
Mr. DeStefano. I will do advertising if you do standards.
That is a deal.
Senator Alexander. Or you can all three do all three. Why
don't we just go across, starting with you, Mr. Potts-Datema.
Mr. Potts-Datema. That is fine.
On the issue of standards, you are absolutely correct,
Senator, that there are not required national standards. There
are, however, voluntary standards in physical education that
have been developed by the National Association for Sport and
Physical Education. Some States have adopted those for their
own standards.
Let me also mention health education, because of course,
nutrition education is a very important component of this. And
there are also voluntary national standards in health education
that have been really championed by the American Cancer Society
but are currently under revision, with the American Association
for Health Education playing a large role in that.
The issue often is that while these standards are good, and
they are quite helpful, of course, States have been really
pressed, and local school districts have been very pressed, for
resources in order to implement them fully. Very few States
require health education or physical education standards, and
no State to my knowledge assesses those standards.
So of course, assessment is really required in order to put
the type of emphasis behind those standards that needs to
happen.
The other issue, of course, in terms of resources is
putting highly-qualified teachers in both health education and
physical education programs and making sure that the facilities
are available, and certainly, the leadership of the Senate and
of Congress on the whole in the Physical Education for Progress
Program has helped with that, and we appreciate the leadership
that has been shown in that issue and providing those
resources.
Senator Alexander. Mr. DeStefano?
Mr. DeStefano. Senator, we do believe that communication is
a great weapon in this issue, and we have created a dialogue
within our own company to talk about that. In 1995, you might
remember a campaign called ``If You Let Me Play,'' where we
focused on women and girls in sport and their opportunity in
sport if you let them play. It was a very inspiring campaign,
and if you look 10 years later, we just had the Women's U.S.
National Team come through the city of Portland, and we saw
20,000 people show up for that game, and some of those girls
who had grown up and played their entire careers with idols
such as Mia Hamm and great role models--I think that is one of
the things that is a true benefit.
So you will see us communicating about that this year, and
as I said in my testimony earlier, we believe that advocacy is
one of our roles and one of our responsibilities and something
you will see us taking a larger voice in on this issue.
Senator Alexander. Thank you.
Mr. Brownson?
Mr. Brownson. Yes, I would like to take the first and the
third. On the first one, I think that the attitude toward
obesity--at least the problem is pretty widespread now. We
track media coverage as part of the IOM work, and the media
coverage has been just enormous in the past several years.
I think what we have less awareness of is the attitudes
toward actually changing behavior and what are the effective
strategies that could be implemented, and how do we do those as
an individual and as part of a family and as part of a school,
a PTA, and then as part of a community.
I think that is the next step of this that we have not done
very well at yet, but we have a lot of good ideas on the table
for it.
On the third one, I think it is an interesting idea. I do
not think it has been that widespread, the issue of insurance
breaks for people who meet standards. It has been done widely
for nonsmokers, so there is precedent that it could be done.
There had been talk about doing that for physical activity
as well, but then you have the problem of how do you know if
someone is needing physical activity or not. And you have some
of the same issues here in terms of measurement, but I think it
is an interesting approach that is an incentive-based program
that could have an effect.
Senator Alexander. Thank you for your comments.
Everyone who wants to change the world wants to start with
the schools because you have a captive audience. And I do not
disagree with that at all, and as I mentioned earlier, and if
you want to talk about an inspiring point for advertising--the
public schools were Americanizing institutions. That is why
they were created. If you come from a country where everybody
looks the same, and their skin is the same, and they have lived
there for centuries, that is one thing. But learning to play
together with people from many different parts of the world is
what America is, and that could be an adjunct to the health
part of this, because it goes to the core of the nature of the
public school.
In our experience with our children, while the focus is
properly on schools, most of the things that our children have
decided to do that we told them to do, they have learned by
example rather than by what we told them. In other words, if
parents exercise and maintain the proper weight and eat right,
that is probably the greatest possible way to affect children,
and I do not have a solution for how to get parents to do it--I
just know that in most of our experience, good examples work
better than good sermons.
I thank the three of you very much for coming. Your
testimony and that of the previous panels is very useful to us.
Senator Frist and Senator Wyden I know will treat this as a
step along the path.
I would like to call on Senator Wyden now for any comments
or questions that he may have.
Senator Wyden. Thank you, Mr. Chairman. I very much
appreciate your thoughtfulness and just have a couple of
questions.
I think, running through the last couple of hours and the
discussion we have had has been this whole debate with respect
to how much can we get done through incentives--call it
``carrots,'' if you will--and how much really requires a stick
and some more aggressive kind of effort.
It has been our sense, and it has been the thrust of this
bipartisan bill I have with the majority leader, that we can
get pretty far down the road with respect to dealing with this
by incentives. But I would just be curious with respect to you
three, and it is almost fitting that we wrap up a couple of
hours' worth of discussion by focusing for a minute or two on
this topic.
Gary, maybe you could start. My sense is that if Nike--and
you all have been wonderful leaders in this--in effect said to
low-income youngsters there is going to be a pair of Nikes out
there for all those of you who lower your blood pressure, lose
weight, that those are the kinds of incentive that make a
difference. But I am curious, and maybe you can start the
discussion on that.
Mr. DeStefano. As we have chatted before, I do believe that
incentives and motivating people is a much better way than
mandating behavior to people; so I agree with the Senator's
comment on that. I think our finding ways to motivate and touch
people's lives and give them access to that behavior that they
want for themselves is the most effective way to make progress
in this disease and this epidemic.
So we are very much focused on that. It is really not our
expertise to mandate or regulate, and we do believe it is our
expertise to inspire and provide opportunities for kids to
play, specifically focusing on children ages 8 to 15 years old.
So that is really where we will put the focus of our programs
and where we believe we can be the best partner for both
government and for other institutions.
Senator Wyden. Mr. Brownson?
Mr. Brownson. Senator, the way I look at incentives, I
think they are one important tool in this issue.
Epidemiologists want to put everything into a table, so when I
think of this as a table, I think of where kids spend their
time--in their homes, in their schools, and out in their
communities--and then, what influences their behavior--their
families, their parents, their friends, the media--you have to
include the media and advertising--and you have to include a
lot of other influences like health care providers or others
who might have contact.
And then, within that table, you have to think of what are
the things within each of those little squares that we could
influence here at the national level and then what needs to
come at the State and local level as well. And I do not have an
example of exactly where the incentives would fit in those, but
I think in each of those boxes, incentives would fit in in some
way.
I think the biggest concern we have had when looking at
this--and I have done a lot of work in rural Missouri looking
at this issue--is that even when people want to be physically
active, sometimes the access is not there, so there is not a
place where they can be physically active; or they want to eat
healthy foods, and the foods are not available in their
communities. So I think access is an important part of that as
well.
Senator Wyden. Mr. Potts-Datema?
Mr. Potts-Datema. Senator, I think we have a good example
of when appropriate resources are given to schools that schools
can do good work in the fresh fruit and vegetable program, for
instance, and the popularity of that program and the leadership
of this body in helping to create that.
I do believe that the quote-unquote ``stick'' issue is
probably important as well, and as we mentioned about
assessments earlier, the lack of health education and physical
education assessments and the accountability that that provides
is a real issue in schools, and helping schools with the
resources to develop the capability to provide effective,
comprehensive health and nutrition education and complete
physical education programs within a coordinated school health
program is really a vital piece of this and could go a long way
toward affecting the childhood overweight epidemic.
I might also mention that the types of public-private
partnerships that we have talked about today, bringing in
different partners from a diverse range of areas, can be very
important to building the support that is necessary to getting
the resources at the local and State level that the schools
need in order to do this work. And public-private partnerships
such as Action for Healthy Kids are working throughout the
country to try to do that, but they are very nascent and need
the support of this body and of everyone.
Senator Wyden. I think that is a good point to close on,
and Senator Alexander is generous. Senator Kennedy and I have
talked a fair amount about this resources issue, and I think he
is absolutely right, particularly with respect to low-income
communities and low-income youngsters. We are just going to
have to find a way to build a coordinated public-private
partnership that is increasingly visible in this area.
I started off a couple of years ago saying that I think the
choice is really stark for this country--you can make a modest
investment today along the lines of what you all and other
witnesses are talking about, or you can pass on that investment
and just play catch-up ball for decades to come, as our people
experience all of these health problems and we rack up medical
bills, diabetes costs, Medicare costs, Medicaid costs, on and
on for years to come.
So you all have been excellent.
Mr. Chairman, let me also particularly thank Senator Frist,
Senator Gregg, and Senator Kennedy's staffs for allowing me to
sit in. I think what we saw today was the opportunity to build
a really aggressive bipartisan coalition. We had superb
witnesses and a lot of very important ideas laid out.
I look forward to working with you as well; when we get
both Senators from Tennessee in our corner, it doesn't get much
better than that.
I thank you for your thoughtfulness.
Senator Alexander. Thank you, Senator Wyden.
Thank you for your testimony, and thanks to all the
witnesses and those who attended today.
The hearing is adjourned.
[Additional material follows.]
ADDITIONAL MATERIAL
Statement of Marshall Manson
Chairman Gregg, Senator Kennedy, Members of the Committee, given
the report earlier this year from the Centers for Disease Control and
Prevention demonstrating that obesity and diseases caused by obesity
are now leading killers In the United States, there can be no question
that obesity is and ought to be a major health concern for all
Americans. In recent months, this ``obesity crisis'' has attracted
significant public and media attention.
Among the central questions now are: whether and, if so, how the
Federal Government should respond,
Some would like to use the heightened focus on obesity to support
their calls for increased Federal regulation of our food choices.
However, these proposals reveal an underlying belief that Americans
cannot make responsible choices about what to eat and drink. For
example, in recent years some groups have pushed such radical
regulatory steps as a new Federal tax on junk food, sodas, and other
snacks (the so-called ``Twinkie tax''), granting the USDA complete
authority to regulate all foods in schools nationwide with an eye
toward banning sodas, cookies, candy and other snacks, and federally
mandated labeling of restaurant menus with detailed nutrition
information.
These anti-food zealots seem to prefer that Americans eat a
federally-mandated diet of lettuce, skinned apples, carrot sticks, and
soy milk. Over the years, they have Identified dozens of foods that
they claim should be eliminated or severely restricted from our diets.
For example, spaghetti and meatballs, eggplant parmigiana, ham
sandwiches, corned beef, pork chops, coffee, enchiladas, gyro
sandwiches, and even luncheon meats. Heaven forbid you enjoy Chinese
takeout. These groups have railed against mu shu pork, General Tso's
chicken, lo mein, kung pao chicken, sweet and sour pork, and Chinese
restaurants, in general. They have even warned against eating the most
basic of American staples--apple pie.
Their conclusions are based on an abundance of questionable studies
and unsupported assertions. However, at this stage, critical scientific
questions about obesity are far from settled.
For example, several studies have concluded that there is no link
between soft drink consumption and obesity while one study made
headlines recently by arguing that there is such a link, There are
conflicting studies over whether milk consumption among children is
rising or falling. One study says that cutting soft drinks does not
increase milk consumption. Another contradicts that conclusion.
Perhaps the most enlightening, undisputed tidbit of scientific
research about obesity comes from a study by researchers at the
University of North Carolina-Chapel Hill. It analyzed health trends in
adolescents over the last 20 years and found that while obesity
increased 10 percent, physical activity decreased 13 percent and
caloric intake remained nearly steady, up 1 percent.
What role should the Federal Government have in combating obesity?
First, we must recognize that there is no single cure-all for obese
Americans. There are literally hundreds of causes of obesity, and there
are as many solutions as there are causes. However, it's important to
note that in and of themselves, sodas, hamburgers, hotdogs, candy,
white breed, rice, potatoes, pasta, and even apple pie don't cause
obesity. Instead, with the exception of medical conditions, obesity
most often results from individuals eating too much while exercising
too little.
Nevertheless, there are limited steps that the government can take
in a general campaign against obesity. For example, the Federal
Government can continue and enhance its efforts to encourage
responsible decision-making, promote increased exercise, and issue
balanced dietary recommendations based on careful, unbiased science.
For that reason, we applaud the kind of public-private partnership that
the committee is discussing today. By helping educate children about
how to make healthy food choices and promoting increased exercise,
especially among children, these sorts of partnerships are precisely
the best way for government to make a difference in the fight against
obesity. Most Importantly, asking local schools, parents, and the
students themselves to develop custom approaches to fighting obesity is
the best way to make a difference.
But above all, the Federal Government's role must, indeed, be
limited. We must recognize that the Federal Government cannot and
should not embark on a massive now regulatory scheme designed to make
us all slimmer and trimmer.
First, there are countless practical problems. Congress cannot
possibly be expected to legislate effectively against obesity, There
are too many causes and too many problems for an omnibus Congressional
solution. Nor is it feasible for Congress to instruct a Federal
regulatory authority to fight obesity through rule-making. Further,
scientific understanding of human nutrition, diet needs, and the causes
of obesity improves constantly. The government is ill-equipped to
understand and integrate these advances into its legislation or
regulation.
Second, and more importantly, the Federal Government shouldn't be
in the business of telling Americans what they can eat and drink. Our
democracy is founded on the idea that individuals have basic freedoms.
Among these, certainly, is the right to choose what we put on our
plates and in our goblets. But the anti-food extremists would gladly
take away that freedom and mandate our diet in order to save us from
ourselves. It is time for these zealous anti food advocates to
understand that it is not the Federal Government's job to save us from
ourselves by making our choices for us.
Obesity has been labeled a ``crisis'' in America. And such labels
all too frequently spur a Congressional impulse to ``don't just sit
there, do something.'' In this case, it's incumbent on Congress to
resist this impulse. Let Americans continue to make free choices about
what to eat and drink. Certainly, the Federal Government can and should
continue to encourage us to make informed choices. Certainly, the
Federal Government can and should help us understand what constitutes a
balanced diet. And certainly, the Federal Government can and should
help us sift through the myriad of scientific, (and unscientific)
information about the right combinations of diet and exercise. Public-
private partnerships that advance these objectives while embracing
local control and individual decision-making are precisely the right
answer, and we applaud Senator Frist's proposal for that reason.
But Congress cannot and should not start down the road of food
regulation or punishment through taxation. In the end, Americans must
make good choices and be responsible for their actions. Were it
otherwise, we would not be truly free.
The Center for Individual Freedom (www.cfif.org) is a
constitutional advocacy organization dedicated to protecting individual
freedom and individual rights.
[Whereupon, at 12:22 p.m., the committee was adjourned.]